Association between hospital liver transplantation volume and mortality after liver re-transplantation.

Seung-Young Oh,Ho Geol Ryu,Hannah Lee,Seokha Yoo,Bo Rim Kim,Nam-Joon Yi,Eun Jin Jang,Ga Hee Kim,Frank Jmf Dor

doi:10.1371/journal.pone.0255655

Abstract

The relationship between institutional liver transplantation (LT) case volume and clinical outcomes after liver re-transplantation is yet to be determined. Patients who underwent liver re-transplantation between 2007 and 2016 were selected from the Korean National Healthcare Insurance Service database. Liver transplant centers were categorized to either high-volume centers (≥ 64 LTs/year) or low-volume centers (< 64 LTs/year) according to the annual LT case volume. In-hospital and long-term mortality after liver re-transplantation were compared. A total of 258 liver re-transplantations were performed during the study period: 175 liver re-transplantations were performed in 3 high-volume centers and 83 were performed in 21 low-volume centers. In-hospital mortality after liver re-transplantation in high and low-volume centers were 25% and 36% (P = 0.069), respectively. Adjusted in-hospital mortality was not different between low and high-volume centers. Adjusted 1-year mortality was significantly higher in low-volume centers (OR 2.14, 95% CI 1.05-4.37, P = 0.037) compared to high-volume centers. Long-term survival for up to 9 years was also superior in high-volume centers (P = 0.005). Other risk factors of in-hospital mortality and 1-year mortality included female sex and higher Elixhauser comorbidity index. Centers with higher case volume (≥ 64 LTs/year) showed lower in-hospital and overall mortality after liver re-transplantation compared to low-volume centers.

Highlights

Liver re-transplantation is the only remaining option for survival in patients who develop graft failure after their primary liver transplantation (LT) [1, 2] and the number of liver re-transplantations are increasing in proportion to the number of primary LTs being performed [3]
A total of 258 liver re-transplantations were performed during the study period: 175 liver retransplantations were performed in 3 high-volume centers and 83 were performed in 21 lowvolume centers
Adjusted 1-year mortality was significantly higher in low-volume centers compared to high-volume centers

Summary

Introduction

Liver re-transplantation is the only remaining option for survival in patients who develop graft failure after their primary liver transplantation (LT) [1, 2] and the number of liver re-transplantations are increasing in proportion to the number of primary LTs being performed [3]. Poor post-transplant survival after liver re-transplantation compared to primary LT have been attributed to surgical complexity and disease progression during the wait time [5, 9, 10] Identified risk factors of poor outcome after liver re-transplantation include higher Model for end-stage liver disease (MELD) scores, old recipient age, cause of graft failure, and prolonged interval between primary LT and liver re-transplantation [5, 7, 11, 12].

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