The center effect in liver transplantation in the Eurotransplant region: a retrospective database analysis

Abstract

Apart from donor and recipient risk factors, the effect of center-related factors has significant impact on graft survival after liver transplantation (LT). To investigate this effect in Eurotransplant, a retrospective database analysis was performed, including all LT's in adult recipients (≥18 years) in the Eurotransplant region from 1.1.2007 until 31.12.2013. Additionally, a survey was sent out to all transplant centers requesting information on surgeons' experience and exposure. In total, 10 265 LT's were included (median follow-up 3.3 years), performed in 39 transplant centers. Funnel plots showed significant differences in graft survival between the transplant centers. After correction for donor and recipient risk, with the Eurotransplant donor risk index (ET-DRI) and the simplified recipient risk index (sRRI) and random effects, these differences diminished. Mean historical volume (in the preceding 5 years) was a significant (P< 0.001), nonlinear marker for graft survival in the multivariate analysis. This study demonstrates that funnel plots can be used for benchmarking purposes in LT. Case-mix correction can be performed with the use of the ET-DRI and sRRI. The center effect encompasses the entire complex process of preoperative workup, operation to follow-up.

Donor Hepatectomy and Implantation Time Are Associated With Early Complications After Liver Transplantation: A Single-center Retrospective Study

“…Indeed, the outcome after liver transplantation is influenced by an important center effect. 19 We also observed a significant difference in the duration of implantation time between transplant surgeons in univariate analysis. However, we did not adjust the analyses for the effect of 'transplant surgeon', since by doing so the effect of implantation time would represent a variation in risk between patients transplanted by the same surgeon and having different durations of implantation time, thereby reducing the generalizability of our results given the monocentric nature of our study.…”

“…Donor, recipient, and postoperative characteristics of the study population are summarized in Table 1. DCD donors accounted for 124 (13.50%) transplants, of which 113 (12.32%) belonged to category-III, and 11 (1.20%) to category-V. 12,13 Median warm ischemia time in DCD was 19 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24) minutes; median agonal warm ischemia was 14 (10)(11)(12)(13)(14)(15)(16)(17)(18) minutes. Total and agonal warm ischemia time in transplants developing early complications equaled that of uncomplicated transplants (Table S1, SDC, http://links.lww.com/TP/B950).…”

Predictive Capacity of Risk Models in Liver Transplantation

“…In comparing center-specific outcomes, risk models may be used to take potential differences in donor and recipient characteristics (case-mix) into account. 18,33 When outcomes of individual transplant centers are not adjusted for donor quality, available “high-risk” liver allografts are likely less used. Effects of a focus on absolute outcomes seems to be already more present in the United States than in Europe; although utilization rates of available livers seem to be similar between both, the quality of transplanted livers is not.…”

Optimizing the Use of Geriatric Livers for Transplantation in the Eurotransplant Region

“…Subsequently, centers were categorized by the median proportion of transplantations performed with livers ≥70 years old as compared with all transplantations performed in that center and included in this study. Then, centers were categorized according to outcome of transplantations with livers ≥70 years in “better than expected,” “worse than expected,” and “as expected” based on the 95% confidence interval (CI) …”