Variation in Biliary Complication Rates Following Liver Transplantation: Implications for Cost and Outcome

Abstract

Although biliary complications (BCs) have a significant impact on the outcome of liver transplantation (LT), variation in BC rates among transplant centers has not been previously analyzed. BC rate, LT outcome and spending were assessed using linked Scientific Registry of Transplant Recipients and Medicare claims (n ¼ 16 286 LTs). Transplant centers were assigned to BC quartiles based upon risk-adjusted observed to expected (O:E) ratio of BC separately for donation after brain death (DBD) and donation after cardiac death (DCD) donors. The median incidence of BC was 300% greater in the highest versus lowest DBD quartiles (19.0% vs. 5.9%) and varied 250% between DCD quartiles (20.3%-8.4%). Donor and recipient characteristics suggest that high BC centers actually used lower donor risk index organs, fewer split livers and fewer imports (p < 0.001 for all). Transplant at a center in the highest O:E quartile was associated with increased posttransplant mortality (adjusted hazard ratio [aHR] 2.53, p ¼ 0.007) in DCD transplant and increased graft loss (aHR 1.21, p ¼ 0.02) in DBD transplant. Medicare spending was $22 895 (p < 0.0001) higher at centers in highest versus lowest BC quartile. In summary, BC rates vary widely among transplant centers and higher rates are a marker for an increased risk of death, graft failure and health-care spending.

Endoscopic versus surgical management of biliary complications – Outcome analysis after 1188 orthotopic liver transplantations

“…This is not in concordance with previous literature, where biliary complications are alleged to have a negative impact on graft and overall survival after liver transplantation [22]. This might be explained by the fact, that the majority of patients with BC in this were treated endoscopically and if successful, survival after liver transplantation was equal to patients without biliary complications.…”

Liver Preservation by Aortic Perfusion Alone Compared With Preservation by Aortic Perfusion and Additional Arterial Ex Situ Back-Table Perfusion With Histidine-Tryptophan-Ketoglutarate Solution: A Prospective, Randomized, Controlled, Multicenter Study

“…The use of grafts from marginal donors and elderly donors has steadily increased during recent years, 9,13 leading to higher risk of developing ITBLs. Donor age is particularly high in Germany (Table 1).…”

Variation in resource utilization in liver transplantation at freestanding children's hospitals

“…It has been shown that post‐transplant complications are likely associated with increasing cost in both children and adults . In a pediatric single‐institution study, a multivariate analysis demonstrated increased LOS and total cost in children with HAT following liver transplantation .…”