Authors' objectives:

This report is a joint initiative of the Spanish National Transplant Organization (Organizacialuaci of the different liver transplantation teams, to develop a basic text that contents the Spanish's today state of the liver transplantation and retransplantation, with its indications and contraindications and the priority criteria to access at these technological and surgical procedures.

Authors' results and conclusions: For some irreversible and progressive hepatopathies OLT is the only way to cure (particularly in children and alcoholic cirrhosis). Otherwise is a debated treatment procedure (positive replication viral hepatitis, and tumours). OLT presents a non negligible mortality risk, although from 1988-1989 changes conduced to improve the five year survival rate as much as 78%. The Spanish data for organ donation, and liver transplantation means the highest rates per million persons in the world. The main indication for OLT in adults was cirrhosis (75% of cases), and far behind retransplantation, fulminant liver failure, and tumours. In children pointed out biliary atresia (30%), retransplantation, fulminant liver failure, metabolic disorders and others. Spanish data shows good survival rates. That rate reached 70% at the fifth post-transplant year in adults, and 80% in children. Urgent versus programmed OLT presents a survival rate of 50-60%, during the first year. Unlike the OLT European Registry, the survival of the OLT in hepatocellular carcinoma in some Spanish series is higher. It could be due to a better selection and to a previous tumour chemoembolization. In the Spanish National Health System (SNS), the economic cost of each OLT surgical procedure included the first post-transplant month is around $55,000 (47,000 - 67,000).

Authors' recommendations: The higher amount of resources should be used in OLT with the best prognosis, like in alcoholic cirrhosis (if alcohol withdrawal is confirmed), cholestasic diseases and all indications in children. Other OLT with acceptable outcomes are fulminant liver failure, non replication hepatitis B virus related diseases, and hepatitis C virus related diseases. A Spanish comprehensive Liver Transplant Registry is now a fundamental need in order to unify coding, to know medium and large term outcomes and to analyse the need and the use of resources.

Project Status: Completed

URL for project: http://www.isciii.es/aets/

Year Published: 1995

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Agencia de Evaluacion de Tecnologias Sanitarias

Contact Address: Instituto de Salud "Carlos III", Calle Sinesio Delgado 6, Pabellon 4, 28029 Madrid, Spain. Tel: +34 9 1 822 2005; Fax: +34 9 1 387 7841;

Contact Name: Luis M. Sánchez Gómez

Contact Email: luism.sanchez@isciii.es

Copyright: Agencia de Evaluacion