WAITING LIST FOR LIVER TRANSPLANTATION: CLINICAL AND ECONOMIC BURDEN

Arq Gastroenterol. 2022 Oct-Dec;59(4):488-493. doi: 10.1590/S0004-2803.202204000-87.

Abstract

Background: Burden of disease is an indicator that relates to health status. United States and European epidemiological data have shown that the burden of chronic liver disease has increased significantly in recent decades. There are no studies evaluating the impact of complications of chronic liver disease on the waiting list for deceased donor liver transplantation (LTx).

Objective: To determine the clinical and economic burden of complications of liver disease in wait-listed patients from the perspective of a transplant center.

Methods: The study retrospectively analyzed medical records of 104 patients wait-listed for deceased donor LTx from October 2012 to May 2016 and whose treatment was fully provided at the study transplant center. Clinical data were obtained from electronic medical records, while economic data were collected from a hospital management software. To allocate all direct medical costs, two methods were used: full absorption costing and micro-costing.

Results: The most common complication was refractory ascites (20.2%), followed by portosystemic encephalopathy (12.5%). The mean number of admissions per patient was 1.37±3.42. Variceal hemorrhage was the complication with longest median length of stay (18 days), followed by hepatorenal syndrome (13.5 days). Hepatorenal syndrome was the costliest complication (mean cost of $3,565), followed by portosystemic encephalopathy ($2,576) and variceal hemorrhage ($1,530).

Conclusion: The burden of chronic liver disease includes a great cost for health systems. In addition, it is likely to be even greater as a result of the insidious course of the disease.

MeSH terms

  • Esophageal and Gastric Varices*
  • Financial Stress
  • Gastrointestinal Hemorrhage
  • Hepatic Encephalopathy*
  • Hepatorenal Syndrome*
  • Humans
  • Liver Transplantation*
  • Living Donors
  • Retrospective Studies
  • Waiting Lists