title: Liver transplantation in the era of cost constraints.
abstract: BACKGROUND
  The issue of containing cost has had a significant impact on organ transplantation. After our institution's 500th liver transplant, we critically examined the impact of the changing health care environment on liver transplantation.
  
  
  METHODS
  We retrospectively analyzed 500 consecutive liver transplants done in the period of 1989 to 1998.
  
  
  RESULTS
  Comparing the first 100 liver transplants to the last 100, patient demographics did not change significantly; however, mean waiting times increased significantly, from 30.4 days to 146.7 days, and median hospital stay decreased from 20.2 days to 10.9 days. One-year patient and graft survivals were not significantly different, 93.6% versus 96.5% and 88.0% versus 95.7%, respectively.
  
  
  CONCLUSIONS
  Despite transplants in patients at higher risk and discharging patients sooner after transplantation, surgical results and patient survivals remained excellent. This was accomplished through improvements and modification of immunosuppression, outpatient treatment of uncomplicated acute rejection, and emphasis on close outpatient follow-up.
authors.affiliation: Department of Surgery, University of Alabama at Birmingham, 35294-0007, USA.
authors.forename: D E
authors.initials: DE
authors.lastname: Eckhoff
authors.forename: B M
authors.initials: BM
authors.lastname: McGuire
authors.forename: C
authors.initials: C
authors.lastname: Young
authors.forename: M T
authors.initials: MT
authors.lastname: Sellers
authors.forename: J L
authors.initials: JL
authors.lastname: Contreras
authors.forename: L R
authors.initials: LR
authors.lastname: Frenette
authors.forename: S L
authors.initials: SL
authors.lastname: Hudson
authors.forename: J S
authors.initials: JS
authors.lastname: Bynon
mesh_terms: D000407:Alabama; D003363:Cost Control; D006084:Graft Rejection; D006801:Humans; D007902:Length of Stay; D008107:Liver Diseases / Q000601:surgery; D016031:Liver Transplantation / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data*; D015397:Program Evaluation; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome