Effect of Institutional Case Volume on In-hospital Mortality After Living Donor Liver Transplantation: Analysis of 7073 Cases Between 2007 and 2016 in Korea

Yoo, Seokha; Jang, Eun Jin; Yi, Nam Joon; Kim, Ga Hee; Kim, Dal Ho; Lee, Hannah; Jung, Chul Woo; Ryu, Ho Geol

doi:10.1097/tp.0000000000002394

Cited by 37 publications

(39 citation statements)

References 39 publications

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“…Liver transplantation (LT) is a major and di cult abdominal operation, and it involves multiple teams administering such things as anesthesia, color Doppler techniques, and critical care. Living donor liver transplantation (LDLT) was associated with a high rate of surgical complications after transplantation, and the hospital mortality rate after LDLT has ranged from 3.6% to 18.9% [1][2][3]. Factors related to inhospital death include infection, a high model for end-stage liver disease (MELD) score, the recipient being of advanced age, and vascular complications such as hepatic artery thrombosis and portal vein thrombosis [3][4].…”

Section: Introductionmentioning

confidence: 99%

Association between surgical volumes and hospital mortality in patients: a living donor liver transplantation single center experience

Hsieh

Hsu

Lin

et al. 2021

Preprint

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Background: Many factors cause hospital mortality (HM) after liver transplantation (LT).Methods: We performed a retrospective research in a single center from October 2005 to June 2019. The study included 463 living donor LT patients. They were divided into a no-HM group (n=433, 93.52%) and an HM group (n=30, 6.48%). We used logistic regression analysis to determine how clinical features and surgical volume affected HM. We regrouped patients based on periods of surgical volume and analyzed the clinical features.Results: Multivariate analysis revealed that donor age (OR= 1.050, 95% CI: 1.011– 1.091, p=0.012), blood loss (OR=1.000, 95% CI: 1.000–1.000, p=0.004), and annual surgical volumes being < 30 LTs (OR=2.540, 95% CI: 1.011–6.381, p=0.047) were significant risk factors. A comparison of years based on surgical volume found that when the annual surgical volumes were at least 30 the recipient age (p=0.023), donor age (p=0.026), and ABO-incompatible operations (p<0.001) were significantly higher and blood loss (p<0.001), operative time (p<0.001), intensive care unit days (p<0.001), length of stay (p=0.011), rate of re-operation (p<0.001), and HM (p=0.030) were significantly lower compared to when the annual surgical volumes were less than 30.Conclusions: Donor age, blood loss and an annual surgical volume < 30 LTs were significant pre- and peri-operative risk factors. Hospital mortality and annual surgical volume were associated with statistically significant differences; surgical volume may impact quality of care and transplant outcomes.

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Section: Introductionmentioning

confidence: 99%

Association between surgical volumes and hospital mortality in patients: a living donor liver transplantation single center experience

Hsieh

Hsu

Lin

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

“…Factors related to inhospital death include infection, a high model for end-stage liver disease (MELD) score, the recipient being of advanced age, and vascular complications such as hepatic artery thrombosis and portal vein thrombosis [3][4]. However, centers with higher surgical volumes (based on annual liver transplantations) had better techniques and multiple team organization compared to centers with lower surgery volumes; higher in-hospital mortality was associated with lower surgical volume centers [1,5]. In this paper, we therefore mainly analyzed hospital mortality in living donor liver transplant patients and tried to pinpoint the factors that in uence postoperative prognosis in order to provide a reference for liver transplant teams.…”

Section: Introductionmentioning

confidence: 99%

Association between surgical volumes and hospital mortality in patients: a living donor liver transplantation single center experience

Hsieh

Hsu

Lin

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Many factors cause hospital mortality (HM) after liver transplantation (LT). Methods: We performed a retrospective research in single center from October 2005 to June 2019. The study included 466 living donor LT patients. They were divided into a no-HM group (n=436, 93.56%) and an HM group (n=30, 6.44%). Logistic regression analysis of factors affecting clinical features and surgical volume of HM. We regrouped patients into met the surgical volume periods based cutoffs of LTs, and analyze the clinical features.Results: Multivariate analysis revealed that donor age (OR= 1.049, 95% CI: 1.011– 1.090, p=0.013), blood loss (OR=1.000, 95% CI: 1.000–1.000, p=0.004), and annual surgical volumes being < 30 LTs (OR=2.521, 95% CI: 1.004–6.332, p=0.049) were significant risk factors. A comparison of years based on surgical volume found that when the annual surgical volumes were at least 30 there was significantly higher recipient age (p=0.022), donor age (p=0.024), and ABO-incompatible operations (p<0.001) and also significantly blood loss (p<0.001), operative time (p<0.001), intensive care unit days (p<0.001), length of stay (p=0.013), re-operative (p<0.001), and HM (p=0.029) compared to when the annual surgical volumes were less than 30. Conclusions: Donor age, blood loss and an annual surgical volume < 30 LTs were significant pre- and peri-operative risk factors. Hospital mortality and annual surgical volume were associated with statistically significant differences; surgical volume may impact quality of care and transplant outcomes.

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“…Liver transplantation is widely performed for end-stage liver failure. Advances in surgical procedures and immunosuppressive therapy significantly improved the outcomes of liver transplantation [ 13 – 15 ]. Postsurgical management of liver transplantation is of great importance in critical care medicine, because large amounts of fluid administration is frequently necessary to maintain intravascular volume and adequate portal vein blood flow to the grafted liver.…”

Section: Introductionmentioning

confidence: 99%

Pulse oximetry-based capillary refilling evaluation predicts postoperative outcomes in liver transplantation: a prospective observational cohort study

et al. 2020

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Background Capillary refill time (CRT) is a non-invasive technique to evaluate tissue perfusion, and quantitative CRT (Q-CRT) adapted to pulse oximetry was developed with patients with sepsis and compared to blood lactate and sepsis scores. In post liver transplantation, large amounts of fluid administration are necessary for maintaining tissue perfusion to grafted liver against intravascular hypovolemia. This study aimed to evaluate whether Q-CRT can predict poor outcomes by detecting peripheral tissue perfusion abnormality in patients with liver transplantations who were treated with massive fluid administration. Methods In this single-center prospective cohort study, we enrolled adult patients with liver transplantations between June 2018 and July 2019. Measurement of Q-CRT was conducted at intensive care units (ICU) admission and postoperative day 1 (POD1). Results A total of 33 patients with liver transplantations were enrolled. Significant correlations of Q-CRT and ΔAb, a tissue oxygen delivery parameter calculated by pulse oximetry data, at ICU admission with the postoperative outcomes such as length of ICU and hospital stay and total amount of ascitic fluid discharge were observed. Quantitative CRT and ΔAb at ICU admission were significantly associated with these postoperative outcomes, even after adjusting preoperative and operative factors (MELD score and bleeding volume, respectively). However, quantitative CRT and ΔAb at POD1 and changes from ICU admission to POD1 failed to show significant associations. Conclusions Q-CRT values were significantly associated with postoperative outcomes in liver transplantation. Although the mechanisms of this association need to be clarified further, Q-CRT may enable identification of high-risk patients that need intensive postoperative managements.

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Effect of Institutional Case Volume on In-hospital Mortality After Living Donor Liver Transplantation: Analysis of 7073 Cases Between 2007 and 2016 in Korea

Abstract: Centers with higher case volume (>50 liver transplantations/year) had better outcomes after living donor liver transplantation, including in-hospital mortality and long-term mortality, compared to centers with lower case volume (≤50 liver transplantations/year).

Cited by 37 publications

References 39 publications

Association between surgical volumes and hospital mortality in patients: a living donor liver transplantation single center experience

Association between surgical volumes and hospital mortality in patients: a living donor liver transplantation single center experience

Association between surgical volumes and hospital mortality in patients: a living donor liver transplantation single center experience

Pulse oximetry-based capillary refilling evaluation predicts postoperative outcomes in liver transplantation: a prospective observational cohort study

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