Cost and outcome of liver transplantation

Liver transplantation is a complex and expensive treatment demanding a large, multidisciplinary team and good healthcare infrastructure. This thesis examines cost and clinical outcome of liver transplantation from a macro- to a micro-perspective. In a systematic review the cost of liver transplantation across countries is compared. The United States have higher mean costs for liver transplantation than other OECD-countries. Second, the influence of different types of postmortem donors on outcome and costs was assessed. Transplantations performed with a liver of a donor that died from circulatory death (DCD) have higher costs than transplantations from brain death donors (DBD). This should have consequences for reimbursement. The international scoring model for donor risk called (Eurotransplant-)Donor Risk Index should be divided into two separate scores, one for DBD- and one for DCD donors. In the next chapter, outcome and costs of restricted versus conventional transfusion policy were compared. The conclusion was that restricted transfusion is safe in liver transplantation. However, costs were not lower. In the final chapter a novel method of detection of hepatic artery thrombosis was assessed. The continuous flow measurement of the hepatic artery did not result in better clinical outcome and had higher costs than regular percutaneous Doppler ultrasound screening. The combination of cost and clinical outcome of liver transplantation can be assessed at different levels. This gives additional information for better decision-making in (the organization of) liver transplantation.