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Assessment of Liver Transplantation

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Title: Assessment of Liver Transplantation.

Agency: Agency for Health Care Policy and Research/Center for Health Care Technology (Formerly, the Office of Health Technology Assessment).

Contact: Steven Hotta, M.D., Ph.D.; Thomas V. Holohan, M.D., Director, CHCT.

Status: Technology Assessment: Published, 1990.

Language: English.

Primary Objective: Update of 1983 PHS report. Review diagnosis-specific survival rates, complications of the procedure, and improved techniques for reducing morbidity and mortality. Identification of patients most likely to benefit from liver transplantation.

Methods Used: Review of published literature, collection of information from major transplant centers and other federal agencies, and contributions from interested public in response to a Federal Register notice of intent to undertake assessment.

Data Identification: Published literature identified by search of the MEDLINE database, references and data submitted by transplant centers, physicians, and other Federal agencies, and cited references in current publications.

Study Selection: Of the more than 400 references collected, 172 were selected for use, because they contained the most reliable data.

Data Extraction: Studies reporting on a meaningful number of cases chosen to assess the outcomes in end-stage-liver-disease patients. Tabulation of the number and outcomes of patients with identifiable liver diseases were utilized to assess whether there was sufficient experience with consistent outcomes reported from transplant centers.

Key Results/Findings: Liver transplantation is effective in extending the lives of carefully selected adult patients who have end-state-liver-disease. The outcome of liver transplantation is influenced by the specific liver disease, the patient's health status, and the presence or absence of extrahepatic disease or disorder.

Conclusions: Survival rates are good for patients with primary biliary cirrhosis, primary sclerosing cholangitis, hepatitis B (antigen negative), alcoholic cirrhosis, alpha-l-antitrypsin deficiency disease, Wilson's disease, and primhemochromatosis.

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