Liver Transplantation at a Small Volume Center—The Role of Network System

Abstract

IntroductionLiver transplantation (LT) is typically performed at specialized, high-volume centers. However, some smaller centers also offer liver transplantation services, but their outcomes and safety have been a subject of debate. To overcome these difficulties, we tried to build a Catholic medical center (CMC) network to share our experiences and overcome the lack of volume. In this study, we reviewed the overall outcome of patients undergoing LT at a small-volume procedure center, with a focus on patient and graft survival rates. MethodsBetween July 2014 and September 2021, 60 adults underwent LT at Bucheon Saint Mary's Hospital. The overall outcomes were analyzed in terms of perioperative outcomes, complications, and overall survival rate. In addition, the patients were divided into a benign end-stage liver disease (ESLD) group (n =44) and a hepatocellular carcinoma (HCC) group (n = 16). The baseline characteristics, perioperative outcomes, complications, and overall survival rate were analyzed between the two groups. ResultsOf a total of 60 LT, living donor liver transplantation (LDLT) was 26, and deceased donor liver transplantation (DDLT) was 34. LDLT was 14 (31.8%) in the ESLD group and 12 (75.0%) in the HCC group. The overall 1-year, 3-year, 5-year survival rates were 86.7%, 79.7%, and 77.7%, respectively. The survival difference was not statistically significant (p=0.214) between the two groups. ConclusionWe suggests that with appropriate patient selection and adequate resources, LT can be safely performed at smaller centers, with the assistance of the CMC network, thus expanding access to this life-saving procedure.