Living donor liver transplantation for early hepatocellular carcinoma: A life-expectancy and cost-effectiveness perspective
Living donor liver transplantation for early hepatocellular carcinoma: A life-expectancy and cost-effectiveness perspective
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DOI：
10.1053/jhep.2001.23311
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发表时间：
2001-05-01
期刊：
影响因子：
13.5
通讯作者：
Hadengue, A
中科院分区：
文献类型：
--
作者：
Sarasin, FP;Majno, PE;Hadengue, A
尸体肝移植（CLT）是早期肝细胞癌（HCC）的一种很好的治疗方法。然而，它的使用受到移植物短缺的限制，高达30%的患者在等待供体时出现了该手术的禁忌症。活体供体肝移植（LDLT）已成为克服这一局限性的替代方法。我们使用马尔可夫模型来比较LDLT和CLT的结果，以平衡供体和受者预期寿命的收益和损失。对于一名60岁的受体，移植后5年生存率为70%，每月退出率为4%，供体死亡率为1%，在等待名单上等待3.5个月后，LDLT比CLT更有效，这些结果随着出现移植禁忌症的可能性、移植后存活率和供体死亡率而变化。对于等待名单上12个月的延迟，LDLT与CLT相比提供的生存期增加在0到2.8生命年之间，这取决于移植后的生存期、等待名单上花费的时间和退出率。在等待名单超过7个月的所有情况下，LDLT具有成本效益（节省的每个质量调整生命年低于50,000美元），当退出率不同时，这个数字从2到16个月不等。当等待名单超过7个月时，LDLT治疗早期HCC的预期寿命显著延长，成本-效果比可接受。预期寿命的增加和LDLT的成本效益更多地取决于移植后的退出率和结果，而不是捐赠者的死亡率。
Cadaveric liver transplantation (CLT) is an excellent treatment for early hepatocellular carcinoma (HCC). Its use, however, is limited by the shortage of grafts, with up to 30% of patients developing contraindications to the procedure while waiting for a donor. Living donor liver transplantation (LDLT) has emerged as an alternative to overcome this limitation. We compared the consequences of LDLT versus CLT using a Markov model balancing the gains and losses in life expectancy among donors and recipients. For a 60-year-old recipient with a 70% 5-year survival after transplantation, a 4% monthly drop-out rate, and a donor with 1% mortality, LDLT became more effective than CLT after 3.5 months on the waiting list, These results varied with the probability of developing contraindications to transplantation, the survival after transplantation, and the donor's mortality. For a 12-month delay saved on the waiting list, the gain in survival provided by LDLT compared with CLT ranged between 0 and 2.8 life years depending on survival after transplantation, time spent on the waiting list, and drop-out rate. LDLT was cost-effective (less than $50,000 per quality-adjusted life year saved) in all scenarios of waiting lists exceeding 7 months, and this figure ranged from 2 to 16 months when varying the drop-out rate. LDLT for early HCC offered substantial gains in life expectancy with acceptable cost-effectiveness ratios when the waiting list exceeds 7 months. The gain in life expectancy and the cost-effectiveness of LDLT were more dependent on the drop-out rate and the outcome after transplantation than on donor's mortality.