Boteon Yuri L, Hessheimer Amelia J, Brüggenwirth Isabel M A, Boteon Amanda P C S, Padilla María, de Meijer Vincent E, Domínguez-Gil Beatriz, Porte Robert J, Perera M Thamara P R, Martins Paulo N
Liver Unit, Hospital Israelita Albert Einstein, São Paulo, Brazil.
Hepatopancreatobiliary Surgery & Transplantation, General & Digestive Surgery Service, Hospital Universitario La Paz, Madrid, Spain.
Artif Organs. 2022 Feb;46(2):191-200. doi: 10.1111/aor.14131. Epub 2021 Dec 8.
Several clinical studies have demonstrated the safety, feasibility, and efficacy of machine perfusion in liver transplantation, although its economic outcomes are still underexplored. This review aimed to examine the costs related to machine perfusion and its associated outcomes.
Expert opinion of several groups representing different machine perfusion modalities. Critical analysis of the published literature reporting the economic outcomes of the most used techniques of machine perfusion in liver transplantation (normothermic and hypothermic ex situ machine perfusion and in situ normothermic regional perfusion).
Machine perfusion costs include disposable components of the perfusion device, perfusate components, personnel and facility fees, and depreciation of the perfusion device or device lease fee. The limited current literature suggests that although this upfront cost varies between perfusion modalities, its use is highly likely to be cost-effective. Optimization of the donor liver utilization rate, local conditions of transplant programs (long waiting list times and higher MELD scores), a decreased rate of complications, changes in logistics, and length of hospital stay are potential cost savings points that must highlight the expected benefits of this intervention. An additional unaccounted factor is that machine perfusion optimizing donor organ utilization allows patients to be transplanted earlier, avoiding clinical deterioration while on the waiting list and the costs associated with hospital admissions and other required procedures.
So far, the clinical benefits have guided machine perfusion implementation in liver transplantation. Albeit there is data suggesting the economic benefit of the technique, further investigation of its costs to healthcare systems and society and associated outcomes is needed.
多项临床研究已证明机器灌注在肝移植中的安全性、可行性和有效性，尽管其经济效果仍未得到充分探索。本综述旨在研究与机器灌注相关的成本及其相关结果。
来自代表不同机器灌注方式的多个小组的专家意见。对已发表文献进行批判性分析，这些文献报道了肝移植中最常用的机器灌注技术（常温及低温体外机器灌注和原位常温区域灌注）的经济结果。
机器灌注成本包括灌注设备的一次性组件、灌注液组件、人员和设施费用以及灌注设备的折旧或设备租赁费用。目前有限的文献表明，尽管这种前期成本在不同灌注方式之间有所不同，但其使用极有可能具有成本效益。优化供肝利用率、移植项目的当地情况（等待名单时间长和终末期肝病模型评分较高）、并发症发生率降低、物流变化以及住院时间是潜在的成本节省点，这些必须突出这种干预措施的预期益处。另一个未考虑的因素是，机器灌注优化供体器官利用可使患者更早接受移植，避免在等待名单上出现临床恶化以及与住院和其他所需程序相关的成本。
到目前为止，临床益处一直指导着机器灌注在肝移植中的应用。尽管有数据表明该技术具有经济效益，但仍需要进一步研究其对医疗保健系统和社会的成本以及相关结果。
