Trasplante hepático: evolución, curva de aprendizaje y resultados después de los primeros 300 casos

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: Retrospecti...

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Autores principales:	Guerra,Juan Francisco, Quezada,José Luis, Cancino,Alejandra, Arrese,Marco, Wolff,Rodrigo, Benítez,Carlos, Pattillo,Juan Carlos, Gana,Juan Cristóbal, Concha,Mario, Cortínez,Luis, Vera,Magdalena, Miranda,Paula, Rubilar,Francisco, Troncoso,Andres, Briceño,Eduardo, Dib,Martín, Jarufe,Nicolás, Martínez,Jorge
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2019
Materias:	Learning Curve Liver Transplantation Survival Analysis
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872019000800955
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spelling	oai:scielo:S0034-988720190008009552019-10-24Trasplante hepático: evolución, curva de aprendizaje y resultados después de los primeros 300 casosGuerra,Juan FranciscoQuezada,José LuisCancino,AlejandraArrese,MarcoWolff,RodrigoBenítez,CarlosPattillo,Juan CarlosGana,Juan CristóbalConcha,MarioCortínez,LuisVera,MagdalenaMiranda,PaulaRubilar,FranciscoTroncoso,AndresBriceño,EduardoDib,MartínJarufe,NicolásMartínez,Jorge Learning Curve Liver Transplantation Survival Analysis 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.info:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.147 n.8 20192019-08-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872019000800955es10.4067/S0034-98872019000800955
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
topic	Learning Curve Liver Transplantation Survival Analysis
spellingShingle	Learning Curve Liver Transplantation Survival Analysis Guerra,Juan Francisco Quezada,José Luis Cancino,Alejandra Arrese,Marco Wolff,Rodrigo Benítez,Carlos Pattillo,Juan Carlos Gana,Juan Cristóbal Concha,Mario Cortínez,Luis Vera,Magdalena Miranda,Paula Rubilar,Francisco Troncoso,Andres Briceño,Eduardo Dib,Martín Jarufe,Nicolás Martínez,Jorge Trasplante hepático: evolución, curva de aprendizaje y resultados después de los primeros 300 casos
description	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.
author	Guerra,Juan Francisco Quezada,José Luis Cancino,Alejandra Arrese,Marco Wolff,Rodrigo Benítez,Carlos Pattillo,Juan Carlos Gana,Juan Cristóbal Concha,Mario Cortínez,Luis Vera,Magdalena Miranda,Paula Rubilar,Francisco Troncoso,Andres Briceño,Eduardo Dib,Martín Jarufe,Nicolás Martínez,Jorge
author_facet	Guerra,Juan Francisco Quezada,José Luis Cancino,Alejandra Arrese,Marco Wolff,Rodrigo Benítez,Carlos Pattillo,Juan Carlos Gana,Juan Cristóbal Concha,Mario Cortínez,Luis Vera,Magdalena Miranda,Paula Rubilar,Francisco Troncoso,Andres Briceño,Eduardo Dib,Martín Jarufe,Nicolás Martínez,Jorge
author_sort	Guerra,Juan Francisco
title	Trasplante hepático: evolución, curva de aprendizaje y resultados después de los primeros 300 casos
title_short	Trasplante hepático: evolución, curva de aprendizaje y resultados después de los primeros 300 casos
title_full	Trasplante hepático: evolución, curva de aprendizaje y resultados después de los primeros 300 casos
title_fullStr	Trasplante hepático: evolución, curva de aprendizaje y resultados después de los primeros 300 casos
title_full_unstemmed	Trasplante hepático: evolución, curva de aprendizaje y resultados después de los primeros 300 casos
title_sort	trasplante hepático: evolución, curva de aprendizaje y resultados después de los primeros 300 casos
publisher	Sociedad Médica de Santiago
publishDate	2019
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872019000800955
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Trasplante hepático: evolución, curva de aprendizaje y resultados después de los primeros 300 casos

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