title: Transplant center volume and outcomes after liver retransplantation.
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.
authors.affiliation: Renal, Hypertension and Electrolyte Division, University of Pennsylvania, Philadelphia, PA, USA. peter.reese@uphs.upenn.edu
authors.forename: P P
authors.initials: PP
authors.lastname: Reese
authors.forename: H
authors.initials: H
authors.lastname: Yeh
authors.forename: A M
authors.initials: AM
authors.lastname: Thomasson
authors.forename: J
authors.initials: J
authors.lastname: Shults
authors.forename: J F
authors.initials: JF
authors.lastname: Markmann
mesh_terms: D000208:Acute Disease; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D015996:Survival Rate; D016896:Treatment Outcome