Fighting Mortality in the Waiting List: Liver Transplantation in North America, Europe, and Asia

Zamora-Valdés, Daniel; Leal-Leyte, Pilar; Kim, Peter T. W.; Testa, Giuliano

doi:10.5604/01.3001.0010.0271

Cited by 28 publications

(16 citation statements)

References 49 publications

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“…There is a discrepancy between the demand for LTx and the number of liver allografts available for transplantation, and decision‐makers should be reluctant to increase the list of transplantable diseases. The limitation of available liver allografts plays a greater role than the costs of LTx in explaining why LTx for CLM has been slow to implement across the world, despite reports of good overall survival.…”

Section: Discussionmentioning

confidence: 99%

“…Another limitation of this study was that the cost of care was valued using DRGs and tariffs that reflect how care providers are reimbursed and not the actual cost of care. However, as they are estimated to reflect the mean cost of care, they are good sources of valuation in cost-effectiveness analyses 28 -30 . There is a discrepancy between the demand for LTx and the number of liver allografts available for transplantation, and decision-makers should be reluctant to increase the list of transplantable diseases 50 . The limitation of available liver allografts plays a greater role than the costs of LTx in explaining why LTx for CLM has been slow to implement across the world, despite reports of good overall survival 11 .…”

Section: Discussionmentioning

confidence: 99%

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Cost-effectiveness of liver transplantation in patients with colorectal metastases confined to the liver

Bjørnelv

Dueland

Line

et al. 2019

Journal of British Surgery

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Background Patients with non‐resectable colorectal metastases are currently treated with chemotherapy. However, liver transplantation can increase the 5‐year survival rate from 9 to 56 per cent if the cancer is confined to the liver. The aim of this study was to estimate the cost‐effectiveness of liver transplantation for colorectal liver metastases. Methods A Markov model with a lifetime perspective was developed to estimate the life‐years, quality‐adjusted life‐years (QALYs), direct healthcare costs and cost‐effectiveness for patients with non‐resectable colorectal liver metastases who received liver transplantation or chemotherapy alone. Results In non‐selected cohorts, liver transplantation increased patients' life expectancy by 3·12 life‐years (2·47 QALYs), at an additional cost of €209 143, giving an incremental cost‐effectiveness ratio (ICER) of €67 140 per life‐year (€84 667 per QALY) gained. In selected cohorts (selection based on tumour diameter, time since primary cancer, carcinoembryonic antigen levels and response to chemotherapy), the effect of liver transplantation increased to 4·23 life‐years (3·41 QALYs), at a higher additional cost (€230 282), and the ICER decreased to €54 467 per life‐year (€67 509 per QALY) gained. Given a willingness to pay of €70 500, the likelihood of transplantation being cost‐effective was 0·66 and 0·94 (0·23 and 0·67 QALYs) for non‐selected and selected cohorts respectively. Conclusion Liver transplantation was cost‐effective but only for highly selected patients. This might be possible in countries with good access to grafts and low waiting list mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Cost-effectiveness of liver transplantation in patients with colorectal metastases confined to the liver

Bjørnelv

Dueland

Line

et al. 2019

Journal of British Surgery

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“…There is a discrepancy between the demand for LTx and the number of liver allografts that are available for transplantation. Decision makers should be reluctant to increase the list of transplantable diseases 52 . The limitation of available liver allografts plays a greater role than the costs of LTx as to why LTx for mCRC has been slow to implement across the world, despite prior reports on good overall survival 11,12 .…”

Section: Policy Implicationsmentioning

confidence: 99%

“…In countries with longer waiting times and higher wait list mortality, LTx for non-resectable mCRC patients might not be a real option for the time being. However, there is a focus on how to increase the access to liver allografts through procedures such as extended donor criteria, split liver transplantation and living donor transplantation 52,53 . If this leads to decreasing waiting times and wait list mortality, LTx for non-resectable mCRC patients might be possible in more countries in the future.…”

Section: Policy Implicationsmentioning

confidence: 99%

Laparoscopic Versus Open Resection for Colorectal Liver Metastases

et al. 2018

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In patients undergoing parenchyma-sparing liver resection for colorectal metastases, laparoscopic surgery was associated with significantly less postoperative complications compared to open surgery. Laparoscopic resection was cost-effective compared to open resection with a 67% probability. The rate of free resection margins was the same in both groups. Our results support the continued implementation of laparoscopic liver resection.

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“…В 1988 г. R. Pichlmayr впервые внедрил идею «разделения» печени от посмертного донора на два фрагмента с возможностью их использования у ребенка и взрослого пациента [1]. В дальнейшем, опираясь на эту методику, были получены долевые трансплантаты с возможностью трансплантации двум взрослым реципиентам, тем самым была продемонстрирована техническая выполнимость сплит-трансплантации печени как взрослым, так и детям [2].…”

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Surgical Aspects of Split Liver Transplantation: а Review

Готье

Latypov

Monakhov

2019

Rossijskij žurnal gastroènterologii, gepatologii, koloproktolog

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Aim. To analyse the surgical aspects of performing a split liver transplantation in patients with end-stage liver disease.Key findings. Split liver transplantation (SLT) is a technique allowing two functional grafts to be obtained from one deceased donor to simultaneously save the lives of two recipients. The global clinical experience of SLT application currently comprises more than three decades. Criteria necessary for successful SLT were developed, based both on assessment of graft quality (age and anthropometric characteristics of the donor, laboratory parameters, ultrasound data, length of stay in intensive care, as well as macroscopic intraoperative assessment of the liver), and on the selection of recipients (primarily in accordance with the height-weight characteristics and the use of the GRWR [graftto-recipient weight ratio]). The use of these criteria allows the results to be achieved comparable to other types of liver transplantation (a whole liver from a deceased donor or liver fragments of an intravital donor). However, issues involved with of the optimal choice of surgical techniques remain to be solved, which include such key aspects as the anatomical method of separation (left lateral section and extended right lobe; anatomical left and right lobes of the liver), an optimal method of separation (ex situ or in situ) and others. The issues of logistics of the SLT application, including the principles of allocation of transplants, also remain significant. Ethical aspects are equally important, since, theoretically, the widespread introduction of the SLT technique may increase the risk of graft loss. The immediate and long-term SLT results require further study, which makes it possible to form a more objective opinion on the effectiveness of the technique.Conclusion. SLT shows good results both in the near and in the remote period. The key aspects of SLT performing are a deep understanding of the variant anatomy of the liver and a high level of knowledge of liver resection surgery. The active use of SLT allows the pool of donor organs to be increased, which is of great importance under the conditions of their permanent lack.

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Fighting Mortality in the Waiting List: Liver Transplantation in North America, Europe, and Asia

Cited by 28 publications

References 49 publications

Cost-effectiveness of liver transplantation in patients with colorectal metastases confined to the liver

Cost-effectiveness of liver transplantation in patients with colorectal metastases confined to the liver

Laparoscopic Versus Open Resection for Colorectal Liver Metastases

Surgical Aspects of Split Liver Transplantation: а Review

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