Living donor liver transplantation for early hepatocellular carcinoma: A life-expectancy and cost-effectiveness perspective

摘要: Cadaveric liver transplantation (CLT) is an excellent treatment for early hepatocellular carcinoma (HCC). Its use, however, limited by the shortage of grafts, with up to 30% patients developing contraindications procedure while waiting a donor. Living donor (LDLT) has emerged as alternative overcome this limitation. We compared consequences LDLT versus CLT using Markov model balancing gains and losses in life expectancy among donors recipients. For 60-year-old recipient 70% 5-year survival after transplantation, 4% monthly drop-out rate, 1% mortality, became more effective than 3.5 months on list. These results varied probability donor's mortality. 12-month delay saved list, gain provided ranged between 0 2.8 years depending time spent rate. was cost-effective (less $50,000 per quality-adjusted year saved) all scenarios lists exceeding 7 months, figure from 2 16 when varying HCC offered substantial acceptable cost-effectiveness ratios list exceeds months. The were dependent rate outcome