肝脏移植的革命性变革:通过原位常温机器灌注过渡到选择性手术 - 效益分析。

IF 7.5 1区 医学 Q1 SURGERY Annals of surgery Pub Date : 2024-11-01 Epub Date: 2024-07-30 DOI:10.1097/SLA.0000000000006462
Zhihao Li, Matthias Pfister, Florian Huwyler, Waldemar Hoffmann, Mark W Tibbitt, Philipp Dutkowski, Pierre-Alain Clavien
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引用次数: 0

摘要

摘要通过收集全球见解和探讨当前的局限性,评估常温机器灌注(NMP)对患者、医疗团队和成本的影响:背景:用于原位肝移植灌注的常温机器灌注因其能够延长移植物保存时间而日益受到关注。它有可能将肝移植(LT)从紧急手术转变为纯粹的选择性手术,这将彻底改变LT的后勤工作,减轻患者和医护人员的负担,并降低成本:方法: 我们向国际移植主任发送了一份包含 31 个项目的调查问卷,以收集他们的 NMP 经验和愿景。此外,我们还对LT的成本分析进行了系统回顾,并评估了将紧急手术转为选择性手术的成本效益研究。我们比较了现有 NMP 的成本,并对 NMP 的成本效益进行了敏感性分析:我们联系了 120 个移植项目,其中 64 个(53%)做出了回应,这些项目分布在北美(31%)、欧洲(42%)、亚洲(22%)和南美(5%)。60%的项目采用了 NMP,北美和欧洲的大型中心(>100 例移植/年)更有可能使用 NMP。主要的 NMP 系统是 OrganOx-metra(39%)、XVIVO(36%)和 TransMedics-OCS(15%)。尽管采用了 NMP,但仍有 41% 的中心在夜间/周末进行超过 50% 的 LT。各中心认识到了 NMP 的好处,包括提高工作满意度和患者疗效,但也面临着高成本和机器复杂性等挑战。16%的中心将投资 100'000-500'000 美元,33%投资 50'000-100'000 美元,38%投资 10'000-50'000 美元,14%投资 40'000 美元/器官:结论:高成本和操作复杂性阻碍了 NMP 的采用。通过 NMP 使 LT 成为选择性手术可降低成本并改善疗效,但要克服障碍,需要国家补偿和用于多天保存的简化、自动化 NMP 系统。
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Revolutionizing Liver Transplantation: Transitioning to an Elective Procedure Through Ex Situ Normothermic Machine Perfusion - A Benefit Analysis.

Objective: To assess the impact of normothermic machine perfusion (NMP) on patients, medical teams, and costs by gathering global insights and exploring current limitations.

Background: NMP for ex situ liver graft perfusion is gaining increasing attention for its capability to extend graft preservation. It has the potential to transform liver transplantation (LT) from an urgent to a purely elective procedure, which could revolutionize LT logistics, reduce burden on patients and health care providers, and decrease costs.

Methods: A 31-item survey was sent to international transplant directors to gather their NMP experiences and vision. In addition, we performed a systematic review on cost-analysis in LT and assessed studies on cost-benefit in converting urgent-to-elective procedures. We compared the costs of available NMPs and conducted a sensitivity analysis of NMP's cost benefits.

Results: Of 120 transplant programs contacted, 64 (53%) responded, spanning North America (31%), Europe (42%), Asia (22%), and South America (5%). Of the total, 60% had adopted NMP, with larger centers (>100 transplants/year) in North America and Europe more likely to use it. The main NMP systems were OrganOx-metra (39%), XVIVO (36%), and TransMedics-OCS (15%). Despite NMP adoption, 41% of centers still perform >50% of LTs at nights/weekends. Centers recognized NMP's benefits, including improved work satisfaction and patient outcomes, but faced challenges like high costs and machine complexity. 16% would invest $100,000 to 500'000, 33% would invest $50,000 to 100'000, 38% would invest $10,000 to 50'000, and 14% would invest <$10,000 in NMP. These results were strengthened by a cost analysis for NMP in emergency-to-elective LT transition. Accordingly, while liver perfusions with disposables up to $10,000 resulted in overall positive net balances, this effect was lost when disposables' cost amounted to >$40,000/organ.

Conclusions: The adoption of NMP is hindered by high costs and operational complexity. Making LT elective through NMP could reduce costs and improve outcomes, but overcoming barriers requires national reimbursements and simplified, automated NMP systems for multiday preservation.

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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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