Indicaciones y contraindicaciones del trasplante y retrasplante hepático

Este documento nació por la inciativa conjunta de la Organización Nacional de Trasplantes (ONT) y la Agencia de Evaluación de Tecnologías Sanitarias (AETS), ante la necesidad compartida por los diferentes equipos de trasplante hepático de disponer de un documento marco que exprese la realidad actual del trasplante y retrasplante hepático en España, y que recoja las indicaciones y contraindicaciones comúnmente aceptadas de estas técnicas, y los criterios de prioridad para el acceso a esta terapéutica.Abreviaturas, Metodología, Introducción, Aspectos generales de las indicaciones, contraindicaciones y factores de riesgo para el trasplante hepático, Trasplante en enfermedades colestásicas Indicaciones y contraindicaciones de crónica parenquimaosa, Trasplantes en hepatitis virales, Fallo hepático fulminante, Tumores, Trasplante hepático pediátrico, Retrasplante, Criterios de prioridad para trasplante y retrasplante hepático, Resumen y conclusiones, Bibliografía, Summary and conclusions, Abstract

Octreotide long-active release in the treatment of gastrointestinal bleeding due to vascular malformations: cost-effectiveness study

Introduction: Gastrointestinal hemorrhage due to vascular malformations has a negative impact on patients' quality of life and consumes an important quantity of resources. Objective: Analyze the cost-effectiveness of long-active releasing octreotide (OCT-LAR) in the treatment of gastrointestinal haemorrhage secondary to vascular malformations. Material and methods: Retrospective study, including 19 pacients that were treated with mensual injections of OCT-LAR between 2008-2013. The number of blood transfusions, hemoglobin levels, hospital admissions and possible side effects during the year before treatment and the year after the start of the treatment were assessed, and cost-effectiveness was analyzed. Results: After the beginning of the treatment with OCT-LAR, complete response was observed in 7 patients (36.8 %), partial response in 7 patients (36.8 %) and 5 patients (26.3 %) continued to require admissions, blood transfusions and/or endoscopic treatment. We observed significant reduction in the length of admission per year (in days) before and after the start of the treatment (22.79 versus 2.01 days, p < 0.0001) as well as in the number of blood transfusions administered (11.19 versus 2.55 blood transfusions per year, p = 0.002). The mean haemoglobin levels increased from 6.9 g/dl to 10.62 g/dl (p < 0.0001). We observed reduction of costs of 61.5 % between the two periods (from 36,072.35 € to 13,867.57 € per patient and year, p = 0.01). No side effects related to treatment were described. Conclusion: In conclusion, OCT-LAR seems to be a cost-efficient and safe pharmacological treatment of gastrointestinal haemorrhage secondary to vascular malformations, mainly in patients in whom endoscopic or surgical treatment is contraindicated