Determinant factors in an expressive increasing of liver transplant in a single center

Abstract

INTRODUCTION: The Clinical Hospital of Sao Paulo University is the biggest hospital of Brazil. Its transplant program was the pioneer in this country and it performed its first liver transplant in 1968. The adult waiting list for liver transplant has about 700 patients nowadays, and it has had more than a thousand some years ago. Even though, our number of liver transplants was not so high (about 50 a year) and we had, as expected, high waiting list mortality. This year we raised significantly our liver transplant number, increasing in 3 times our past few years’ average. AIM: We would like to highlight the determinant factors in this expressive increasing number of liver transplants in a single center in Brazil. METHODS: We analyzed the number of liver transplants in the same period of the year (from January to September) in 2008 and 2009 at the Clinical Hospital of Sao Paulo University Medical School. It was evaluated the reasons of the increasing rate of liver transplants in 2009 at this center. RESULTS: Comparing the period from January to September 2008 with the same period of 2009, the liver transplant number increased 200% (35 to 105) .Mass media, public health system policy, transplant team organization, hospitalization of critical patients, preoperative prepare, acceptance of expanded criteria donors, living donor program, and split livers were determinant in this raising of liver transplants at this institution. The actuarial survival rate improved with the increasing number of liver transplants (75% to 85%). CONCLUSION: It is still possible to increase the number of liver transplants in developing countries. The mechanism of such change is multifactorial and it needs government, institutional and multidisciplinary efforts. Besides the use of marginal and split livers, the increasing rate of transplants is related to better outcome.