Transplant Center Volume and Outcomes After Liver Retransplantation
Liver retransplantation surgery has a high rate of allograft failure due to patient comorbidities and technical demands of the procedure. Success of liver retransplantation could depend on surgeon experience and processes of care that relate to center volume. We performed a retrospective cohort stud...
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| Veröffentlicht in: | American journal of transplantation 2009-02, Vol.9 (2), p.309-317 |
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| creator | Reese, P. P. Yeh, H. Thomasson, A. M. Shults, J. Markmann, J. F. |
| description | Liver retransplantation surgery has a high rate of allograft failure due to patient comorbidities and technical demands of the procedure. Success of liver retransplantation could depend on surgeon experience and processes of care that relate to center volume. We performed a retrospective cohort study of adult liver retransplantation procedures performed from January 1, 1996 through December 31, 2005 using registry data from the Organ Procurement Transplantation Network. The primary outcome was 1‐year allograft failure. Liver transplant centers were categorized as small, intermediate or high volume by dividing overall liver transplants into three tertiles of approximately equal size. Mean annual volume of overall liver transplants was 88 for high‐volume centers. The primary analysis consisted of 3977 liver retransplantation patients. The unadjusted risk of 1‐year allograft failure was 37.8%. In multivariable logistic regression, the risk of 1‐year allograft failure was not significantly different between low‐ (reference), intermediate‐ (OR 0.86, CI 0.72–1.03, p = 0.11) and high‐volume centers (OR 0.88, CI 0.74–1.04, p = 0.14). Results were similar when the analysis was limited to retransplantation performed >160 days after initial transplantation. Center volume is an imprecise surrogate measure for 1‐year outcomes after liver retransplantation.
A retrospective review of OPTN data on 3977 retransplants found that center volume was not a major factor in outcomes. |
| doi_str_mv | 10.1111/j.1600-6143.2008.02488.x |
| format | Article |
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A retrospective review of OPTN data on 3977 retransplants found that center volume was not a major factor in outcomes.</description><identifier>ISSN: 1600-6135</identifier><identifier>EISSN: 1600-6143</identifier><identifier>DOI: 10.1111/j.1600-6143.2008.02488.x</identifier><identifier>PMID: 19120081</identifier><language>eng</language><publisher>Malden, USA: Blackwell Publishing Inc</publisher><subject>Acute Disease ; Adult ; Biological and medical sciences ; Center volume ; Cohort Studies ; Female ; Graft Survival - physiology ; health services research ; Humans ; Incidence ; liver retransplantation ; Liver Transplantation - mortality ; Liver Transplantation - statistics & numerical data ; Male ; Medical sciences ; Middle Aged ; Miscellaneous ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Quality of Health Care ; Reoperation - mortality ; Reoperation - statistics & numerical data ; Retrospective Studies ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery Department, Hospital - statistics & numerical data ; Survival Rate ; Treatment Outcome</subject><ispartof>American journal of transplantation, 2009-02, Vol.9 (2), p.309-317</ispartof><rights>2009 The Authors Journal compilation © 2009 The American Society of Transplantation and the American Society of Transplant Surgeons</rights><rights>2009 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4788-9cbc73069626c0da50c2510b7087e13124b21fe0fcf98fec1410fc753cf99a763</citedby><cites>FETCH-LOGICAL-c4788-9cbc73069626c0da50c2510b7087e13124b21fe0fcf98fec1410fc753cf99a763</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fj.1600-6143.2008.02488.x$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fj.1600-6143.2008.02488.x$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=21120208$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19120081$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Reese, P. P.</creatorcontrib><creatorcontrib>Yeh, H.</creatorcontrib><creatorcontrib>Thomasson, A. M.</creatorcontrib><creatorcontrib>Shults, J.</creatorcontrib><creatorcontrib>Markmann, J. F.</creatorcontrib><title>Transplant Center Volume and Outcomes After Liver Retransplantation</title><title>American journal of transplantation</title><addtitle>Am J Transplant</addtitle><description>Liver retransplantation surgery has a high rate of allograft failure due to patient comorbidities and technical demands of the procedure. Success of liver retransplantation could depend on surgeon experience and processes of care that relate to center volume. We performed a retrospective cohort study of adult liver retransplantation procedures performed from January 1, 1996 through December 31, 2005 using registry data from the Organ Procurement Transplantation Network. The primary outcome was 1‐year allograft failure. Liver transplant centers were categorized as small, intermediate or high volume by dividing overall liver transplants into three tertiles of approximately equal size. Mean annual volume of overall liver transplants was <50 for low‐volume centers, 50–88 for intermediate‐volume centers and >88 for high‐volume centers. The primary analysis consisted of 3977 liver retransplantation patients. The unadjusted risk of 1‐year allograft failure was 37.8%. In multivariable logistic regression, the risk of 1‐year allograft failure was not significantly different between low‐ (reference), intermediate‐ (OR 0.86, CI 0.72–1.03, p = 0.11) and high‐volume centers (OR 0.88, CI 0.74–1.04, p = 0.14). Results were similar when the analysis was limited to retransplantation performed >160 days after initial transplantation. Center volume is an imprecise surrogate measure for 1‐year outcomes after liver retransplantation.
A retrospective review of OPTN data on 3977 retransplants found that center volume was not a major factor in outcomes.</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>Center volume</subject><subject>Cohort Studies</subject><subject>Female</subject><subject>Graft Survival - physiology</subject><subject>health services research</subject><subject>Humans</subject><subject>Incidence</subject><subject>liver retransplantation</subject><subject>Liver Transplantation - mortality</subject><subject>Liver Transplantation - statistics & numerical data</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Quality of Health Care</subject><subject>Reoperation - mortality</subject><subject>Reoperation - statistics & numerical data</subject><subject>Retrospective Studies</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery Department, Hospital - statistics & numerical data</subject><subject>Survival Rate</subject><subject>Treatment Outcome</subject><issn>1600-6135</issn><issn>1600-6143</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkMtOwzAQRS0EolD4BZQN7BJm7MRxFiyqiqcqVUKFreW4jpQqjxIn0P49Do3CErywx5pz7dEhxEMI0K3bTYAcwOcYsoACiABoKESwOyJnY-N4rFk0IefWbgAwpoKekgkm2MfwjMxXjarstlBV681N1ZrGe6-LrjSeqtbesmt1XRrrzbK-s8g_3f5q2jGj2ryuLshJpgprLodzSt4e7lfzJ3-xfHyezxa-DmMh_ESnOmbAE065hrWKQNMIIY1BxAYZ0jClmBnIdJaIzGgM0dVxxNw9UTFnU3JzeHfb1B-dsa0sc6tN4QYxdWcl54IzzuI_QQohIBehA8UB1E1tbWMyuW3yUjV7iSB703Ije4myFyp7ZfLHtNy56NXwR5eWZv0bHNQ64HoAlNWqyJwznduRo-g4CsJxdwfuKy_M_t8DyNnLqq_YN75ZmDs</recordid><startdate>200902</startdate><enddate>200902</enddate><creator>Reese, P. P.</creator><creator>Yeh, H.</creator><creator>Thomasson, A. 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F.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4788-9cbc73069626c0da50c2510b7087e13124b21fe0fcf98fec1410fc753cf99a763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Acute Disease</topic><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>Center volume</topic><topic>Cohort Studies</topic><topic>Female</topic><topic>Graft Survival - physiology</topic><topic>health services research</topic><topic>Humans</topic><topic>Incidence</topic><topic>liver retransplantation</topic><topic>Liver Transplantation - mortality</topic><topic>Liver Transplantation - statistics & numerical data</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Miscellaneous</topic><topic>Public health. Hygiene</topic><topic>Public health. 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F.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Transplant Center Volume and Outcomes After Liver Retransplantation</atitle><jtitle>American journal of transplantation</jtitle><addtitle>Am J Transplant</addtitle><date>2009-02</date><risdate>2009</risdate><volume>9</volume><issue>2</issue><spage>309</spage><epage>317</epage><pages>309-317</pages><issn>1600-6135</issn><eissn>1600-6143</eissn><abstract>Liver retransplantation surgery has a high rate of allograft failure due to patient comorbidities and technical demands of the procedure. Success of liver retransplantation could depend on surgeon experience and processes of care that relate to center volume. We performed a retrospective cohort study of adult liver retransplantation procedures performed from January 1, 1996 through December 31, 2005 using registry data from the Organ Procurement Transplantation Network. The primary outcome was 1‐year allograft failure. Liver transplant centers were categorized as small, intermediate or high volume by dividing overall liver transplants into three tertiles of approximately equal size. Mean annual volume of overall liver transplants was <50 for low‐volume centers, 50–88 for intermediate‐volume centers and >88 for high‐volume centers. The primary analysis consisted of 3977 liver retransplantation patients. The unadjusted risk of 1‐year allograft failure was 37.8%. In multivariable logistic regression, the risk of 1‐year allograft failure was not significantly different between low‐ (reference), intermediate‐ (OR 0.86, CI 0.72–1.03, p = 0.11) and high‐volume centers (OR 0.88, CI 0.74–1.04, p = 0.14). Results were similar when the analysis was limited to retransplantation performed >160 days after initial transplantation. Center volume is an imprecise surrogate measure for 1‐year outcomes after liver retransplantation.
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| subjects | Acute Disease Adult Biological and medical sciences Center volume Cohort Studies Female Graft Survival - physiology health services research Humans Incidence liver retransplantation Liver Transplantation - mortality Liver Transplantation - statistics & numerical data Male Medical sciences Middle Aged Miscellaneous Public health. Hygiene Public health. Hygiene-occupational medicine Quality of Health Care Reoperation - mortality Reoperation - statistics & numerical data Retrospective Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery Department, Hospital - statistics & numerical data Survival Rate Treatment Outcome |
| title | Transplant Center Volume and Outcomes After Liver Retransplantation |
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