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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

Yoo, Seokha, MD1; Jang, Eun Jin, PhD2; Yi, Nam-Joon, MD, PhD3; Kim, Ga Hee, BS4; Kim, Dal Ho, PhD4; Lee, Hannah, MD, PhD1; Jung, Chul-Woo, MD, PhD1; Ryu, Ho Geol, MD, PhD1

doi: 10.1097/TP.0000000000002394
Original Clinical Science—Liver
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Background. The relationship between institutional case volume and clinical outcomes after living donor liver transplantation is not clarified.

Methods. We conducted a nationwide retrospective cohort study using the database of Korean National Healthcare Insurance Service. Between January 2007 and December 2016, 7073 adult living donor liver transplantations were performed at 50 centers in Korea. Centers were categorized according to the average annual number of liver transplantations: >50, 10 to 50, and <10.

Results. In-hospital mortality rates in the high-, medium-, and low-volume centers were 2.8%, 4.1%, and 6.7%, respectively. After adjustment, in-hospital mortality was significantly higher in low-volume centers (adjusted odds ratio, 2.287; 95% confidence interval, 1.471-3.557; P < 0.001) and medium-volume centers (adjusted odds ratio, 1.676; 95% confidence interval, 1.089-2.578; P = 0.019) compared with high-volume centers. Long-term survival for up to 9 years was better, and intensive care unit and hospital length of stay were shorter in high-volume centers.

Conclusions. 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 with centers with lower case volume (≤50 liver transplantations/year).

1 Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

2 Department of Information Statistics, Andong National University, Gyeongsangbuk-do, Republic of Korea.

3 Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.

4 Department of Statistics, Kyungpook National University, Daegu, Republic of Korea.

Received 28 February 2018. Revision received 18 July 2018.

Accepted 23 July 2018.

S.Y. and E.J.J. contributed equally to this work and are co-first authors.

The authors declare no funding or conflicts of interest.

S.Y. participated in the study design, data analysis, and first draft of the article. E.J.J. participated in the data acquisition, data analysis, and first draft of the article. N.J.Y. participated in the revision of the article. G.H.K. participated in the data acquisition and data analysis. D.H.K. participated in the data acquisition and data analysis. H.L. participated in the study conception and revision of the article. C.W.J. participated in the study design and revision of the article. H.G.R. participated in the study conception, study design, and revision of the article.

Correspondence: Ho Geol Ryu, MD, PhD, Seoul National University Hospital, Seoul National University College of Medicine, Daehak-ro 101, Jongno-gu, Seoul, 03080, Republic of Korea. (hogeol@gmail.com).

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