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Revista médica de Chile

Print version ISSN 0034-9887

Abstract

GUERRA, Juan Francisco et al. Liver transplantation: development, learning curve and results after the first 300 cases. Rev. méd. Chile [online]. 2019, vol.147, n.8, pp.955-964. ISSN 0034-9887.  http://dx.doi.org/10.4067/S0034-98872019000800955.

Background:

Liver transplantation (LT) is an option for people with liver failure who cannot be cured with other therapies and for some people with liver cancer.

Aim:

To describe, and analyze the first 300 LT clinical results, and to establish our learning curve.

Material and Methods:

Retrospective cohort study with data obtained from a prospectively collected LT Program database. We included all LT performed at a single center from March 1994 to September 2017. The database gathered demographics, diagnosis, indications for LT, surgical aspects and postoperative courses. We constructed a cumulative summation test for learning curve (LC-CUSUM) using 30-day post-LT mortality. Mortality at 30 days, and actuarial 1-, and 5-year survival rate were analyzed.

Results:

A total of 281 patients aged 54 (0-71) years (129 women) underwent 300 LT. Ten percent of patients were younger than 18 years old. The first, second and third indications for LT were non-alcoholic steatohepatitis, chronic autoimmune hepatitis and alcoholic liver cirrhosis, respectively. Acute liver failure was the LT indication in 51 cases (17%). The overall complication rate was 71%. Infectious and biliary complications were the most common of them (47 and 31% respectively). The LC-CUSUM curve shows that the first 30 patients corresponded to the learning curve. The peri-operative mortality was 8%. Actuarial 1 and 5-year survival rates were 82 and 71.4%, respectively.

Conclusions:

Outcome improvement of a LT program depends on the accumulation of experience after the first 30 transplants and the peri-operative mortality directly impacted long-term survival.

Keywords : Learning Curve; Liver Transplantation; Survival Analysis.

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