Varona M A, Soriano A, Aguirre-Jaime A, Barrera M A, Medina M L, Bañon N, Mendez S, Lopez E, Portero J, Dominguez D, Gonzalez A
Department of Surgery, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain.
Transplant Proc. 2012 Jul-Aug;44(6):1517-22. doi: 10.1016/j.transproceed.2012.05.009.
Liver transplantation, the best option for many end-stage liver diseases, is indicated in more candidates than the donor availability. In this situation, this demanding treatment must achieve excellence, accessibility and patient satisfaction to be ethical, scientific, and efficient. The current consensus of quality measurements promoted by the Sociedad Española de Trasplante Hepático (SETH) seeks to depict criteria, indicators, and standards for liver transplantation in Spain. According to this recommendation, the Canary Islands liver program has studied its experience. We separated the 411 cadaveric transplants performed in the last 15 years into 2 groups: The first 100 and the other 311. The 8 criteria of SETH 2010 were correctly fulfilled. In most indicators, the outcomes were favorable, with an actuarial survivals at 1, 3, 5, and 10 years of 84%, 79%, 76%, and 65%, respectively; excellent results in retransplant rates (early 0.56% and long-term 5.9%), primary nonfunction rate (0.43%), waiting list mortality (13.34%), and patient satisfaction (91.5%). On the other hand, some indicators of mortality were worse as perioperative, postoperative, and early mortality with normal graft function and reoperation rate. After the analyses of the series with statistical quality control charts, we observed an improvement in all indicators, even in the apparently worst, early mortality with normal graft functions in a stable program. Such results helped us to discover specific areas to improve the program. The application of the quality measurement, as SETH consensus recommends, has shown in our study that despite being a consuming time process, it is a useful tool.
肝移植是许多终末期肝病的最佳选择，符合肝移植指征的候选者人数多于供体数量。在这种情况下，这种要求严苛的治疗必须在伦理、科学和效率方面达到卓越、可及性和患者满意度。西班牙肝脏移植协会（SETH）目前倡导的质量衡量共识旨在描述西班牙肝移植的标准、指标和规范。根据这一建议，加那利群岛肝脏移植项目对其经验进行了研究。我们将过去15年里进行的411例尸体肝移植分为两组：前100例和另外311例。2010年SETH的8项标准均得到正确满足。在大多数指标上，结果是良好的，1年、3年、5年和10年的精算生存率分别为84%、79%、76%和65%；再次移植率（早期为0.56%，长期为5.9%）、原发性无功能率（0.43%）、等待名单死亡率（13.34%）和患者满意度（91.5%）方面的结果都很出色。另一方面，一些死亡率指标较差，如围手术期、术后以及移植物功能正常时的早期死亡率和再次手术率。在用统计质量控制图对该系列进行分析后，我们观察到所有指标都有所改善，即使是在看似最差的稳定项目中移植物功能正常时的早期死亡率方面。这些结果帮助我们发现了该项目需要改进的具体领域。正如SETH共识所建议的，质量衡量的应用在我们的研究中表明，尽管这是一个耗时的过程，但它是一个有用的工具。
