Analysis of differences in outcome of two European liver transplant centers

Abstract

Summary Authors analyzed the differences in the outcome of two European liver transplant centers differing in case volume and experience. The first was the Transplantation and Surgical Clinic, Semmelweis University, Budapest, Hungary (SEB) and the second the University Medical Center Groningen, Groningen, The Netherlands (UMCG). We investigated if such differences could be explained. The 1‐, 3‐ and 5‐year patient survival in the UMCG was 86%, 80%, and 77% compared with 65%, 56%, and 55% in SEB. Graft survival at the same time points was 79%, 71%, and 66% in the UMCG and 62%, 55%, and 53% in SEB. Significant differences were present regarding the donor and recipient age, diagnosis mix, disease severity and operation variables, per‐operative transfusion rate, vascular complications, postoperative infection rate, and need for renal replacement. To determine factors correlating with survival, a separate uni‐ and multivariate analysis was performed in each center individually, between study parameters and patient survival. In both centers, peri‐operative red blood cell (RBC) transfusion rate was a significant predictor for patient survival. The difference in blood loss can be explained by different operation techniques and shorter operation time in SEB, with consequently less time spent on hemostasis. It was jointly concluded that measures to reduce blood loss by adapting the operation technique might lead to improved survival and reduced morbidity.

Follow-up of Chinese liver transplant recipients in Hong Kong

“…The 5‐year survival rate of the China group patients was compromised by the higher incidence of HCC patients who subsequently died of cancer recurrence. For non‐HCC patients, the 5‐year survival rate was 66.3%, which is similar to the graft survival rates of recent reports of large cohorts of patients in the Western world (55%‐72%) 15–20. A major concern is that about 60% of the surviving patients did not have completely normal liver biochemistry at the latest follow‐up.…”

Management and patient survival in hepatocellular carcinoma: Does the physician's level of experience matter?

“…The major obstacle is how to define the ‘level of experience’. There are some reports in the literature regarding the influence of experience on disease outcome, as shown by studies as liver transplantation, 7 liver resection for adult HCC, 19 and pediatric primary liver malignancies 20 . Experience could also have an impact upon the complication of RFA procedures 21 or quality of colonoscopy 22 .…”

“…The level of the physician's experience could alter the disease outcome, and this could be best explained by liver transplantation 7 . In the real world, not all patients with HCC are properly managed by the high‐volume physicians who are authoritative on HCC management, and the clinical impact of experienced hepatologists upon the survival of such patients is still unknown.…”

“…4,6 The level of the physician's experience could alter the disease outcome, and this could be best explained by liver transplantation. 7 In the real world, not all patients with HCC are properly managed by the high-volume physicians who are authoritative on HCC management, and the clinical impact of experienced hepatologists upon the survival of such patients is still unknown. The aims of this study are to compare the differences in baseline discrepancies, adopted therapies, and prognostic determinants between patients managed by high-and low-volume physicians with differing experience in HCC management, and their influence on the disease outcome.…”

Hepatitis E virus genotype 3 is a common finding in liver‐transplanted patients undergoing liver biopsy for elevated liver enzymes with a low De Ritis ratio and suspected acute rejection: A real‐world cohort

“…While suspecting a rejection episode, other diagnoses are found by liver biopsy in 54% of cases . Due to different underlying diseases, frequency of rejection or other reasons for elevated liver enzymes can vary from center to center …”