肝脏杂志：疾病与移植

Economic Impact of Liver Transplantation for Acute Liver Failure

F Elgilani, JM Glorioso, MA Hathcock, WK Kremers, and SL Nyberg

Current treatment of Acute Liver Failure (ALF) consists of standard medical therapy to bridge patients to spontaneous recovery or liver transplantation. The aim of this study was to assess the economic
implications of liver transplantation in ALF patients and to evaluate the potential financial benefit of an alternative therapy, such as the bioartificial liver, for treatment of ALF.

Mayo Liver Transplant Database was utilized to gain information on all patients listed for liver transplant at our center from January 2003 to April 2013. Standardized costs from the Mayo Clinic Cost Data Warehouse were used to describe relative costs of medical care from admission to 30, 90 and 365 days later for each group in this study. Patient survival analysis was conducted to compare outcomes.Costs calculations were made in 757 patients who were listed for liver transplantation including 58 with a diagnosis of ALF. We observed that the adjusted total cost of medical care was significantly lower in ALF patients who recovered without transplantation compared to those ALF patients who required liver transplantation. Survival analysis in both groups reveals no evidence that transplantation increases patient survival (p = 0.31).As expected, mean cost of healthcare increased with time since ALF diagnosis in both groups, but remained significantly lower in ALF patients who avoided transplant: $34,828 vs. $143,922,at 30 days (P<0.001), $ 36,342 vs. $177,495 at 90 days (P<0.001),and $48,808 vs. $198,223 at 1 year (P<0.001), respectively. In a second comparison, hospitalization and post-discharge costs after liver transplantation were higher for ALF patients compared to patients listed with a diagnosis of cirrhosis (P<0.01). The difference in cost between ALF and cirrhotic recipients became insignificant beyond 30days of transplantation.

Conclusion: Liver transplantation as a treatment of ALF is ahigh cost procedure. Alternative therapies, such as the bioartificial liver, if successful in avoiding transplantation, would have a great economic impact.