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Effect of Case Volume on Mortality After Pediatric Liver Transplantation in Korea

Lee, Hannah MD, PhD1; Jang, Eun Jin PhD2; Kim, Ga Hee3; Yi, Nam Joon MD, PhD4; Kim, Dal Ho PhD3; Yoo, Seokha MD1; Row, Hyung Sang MD1; Jung, Chul-Woo MD, PhD1; Oh, Seung-Young MD4; Ryu, Ho Geol MD, PhD1

doi: 10.1097/TP.0000000000002522
Original Clinical Science—Liver
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Background. The purpose of this study was to evaluate whether institutional case-volume affects clinical outcomes after pediatric liver transplantation.

Methods. We conducted a nationwide retrospective cohort study using the database of Korean National Healthcare Insurance Service. Between January 2007 and December 2016, 521 pediatric liver transplantations were performed at 22 centers in Korea. Centers were categorized according to the average annual number of liver transplantations: >10, 1 to 10, and <1.

Results. In-hospital mortality rates in the high-, medium-, and low-volume centers were 5.8%, 12.5%, and 32.1%, respectively. After adjustment, in-hospital mortality was significantly higher in low-volume centers (adjusted odds ratio, 9.693; 95% confidence interval, 4.636-20.268; P < 0.001) and medium-volume centers (adjusted odds ratio, 3.393; 95% confidence interval, 1.980-5.813; P < 0.001) compared to high-volume centers. Long-term survival for up to 9 years was better in high-volume centers.

Conclusions. Centers with higher case volume (>10 pediatric liver transplantations/y) had better outcomes after pediatric liver transplantation, including in-hospital mortality and long-term mortality, compared to centers with lower case volume (≤10 liver transplantations/y).

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

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

Received 6 August 2018. Revision received 10 October 2018.

Accepted 29 October 2018.

H.L. and E.J.J. equally contributed to this work and are co-first authors.

H.G.R., E.J.J., and H.L. designed the study. H.L., E.J.J., and H.G.R wrote the article. E.J.J., G.H.K. and D.H.K. analyzed the data. S.Y., H.S.R., C.W.J., and S.Y.O. participated in the performance of the research. C.W.J. and H.S.R. collected the data. N.J.Y. and S.Y.O. provided feedback and suggestions.

The authors declare no funding or conflicts of interest.

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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