BACKGROUND AND OBJECTIVE: Surgical mortality in the US is widely perceived to be superior to that in the UK. However, previous comparisons of surgical outcome in the two countries have often failed to take sufficient account of case-mix or examine long-term outcome. The standardised nature of liver transplantation practice makes it uniquely placed for undertaking reliable international comparisons of surgical outcome. The objective of this study is to undertake a risk-adjusted disease-specific comparison of both short- and long-term survival of liver transplant recipients in the UK and Ireland with that in the US. METHODS: A multicentre cohort study using two high quality national databases including all adults who underwent a first single organ liver transplant in the UK and Ireland (n = 5925) and the US (n = 41,866) between March 1994 and March 2005. The main outcome measures were post-transplant mortality during the first 90 days, 90 days to 1 year and beyond the first year, adjusted for recipient and donor characteristics. RESULTS: Risk-adjusted mortality in the UK and Ireland was generally higher than in the US during the first 90 days (HR 1.17; 95% CI 1.07 to 1.29), both for patients transplanted for acute liver failure (HR 1.27; 95% CI 1.01 to 1.60) and those transplanted for chronic liver disease (HR 1.18; 95% CI 1.07 to 1.31). Between 90 days and 1 year post-transplantation, no statistically significant differences in overall risk-adjusted mortality were noted between the two cohorts. Survivors of the first post-transplant year in the UK and Ireland had lower overall risk-adjusted mortality than those transplanted in the US (HR 0.88; 95% CI 0.81 to 0.96). This difference was observed among patients transplanted for chronic liver disease (HR 0.88; 95% CI 0.81 to 0.96), but not those transplanted for acute liver failure (HR 1.02; 95% CI 0.70 to 1.50). CONCLUSIONS: Whilst risk-adjusted mortality is higher in the UK and Ireland during the first 90 days following liver transplantation, it is higher in the US among those liver transplant recipients who survived the first post-transplant year. Our results are consistent with the notion that the US has superior acute perioperative care whereas the UK appears to provide better quality chronic care following liver transplantation surgery.
BACKGROUND AND OBJECTIVE: Surgical mortality in the US is widely perceived to be superior to that in the UK. However, previous comparisons of surgical outcome in the two countries have often failed to take sufficient account of case-mix or examine long-term outcome. The standardised nature of liver transplantation practice makes it uniquely placed for undertaking reliable international comparisons of surgical outcome. The objective of this study is to undertake a risk-adjusted disease-specific comparison of both short- and long-term survival of liver transplant recipients in the UK and Ireland with that in the US. METHODS: A multicentre cohort study using two high quality national databases including all adults who underwent a first single organ liver transplant in the UK and Ireland (n = 5925) and the US (n = 41,866) between March 1994 and March 2005. The main outcome measures were post-transplant mortality during the first 90 days, 90 days to 1 year and beyond the first year, adjusted for recipient and donor characteristics. RESULTS: Risk-adjusted mortality in the UK and Ireland was generally higher than in the US during the first 90 days (HR 1.17; 95% CI 1.07 to 1.29), both for patients transplanted for acute liver failure (HR 1.27; 95% CI 1.01 to 1.60) and those transplanted for chronic liver disease (HR 1.18; 95% CI 1.07 to 1.31). Between 90 days and 1 year post-transplantation, no statistically significant differences in overall risk-adjusted mortality were noted between the two cohorts. Survivors of the first post-transplant year in the UK and Ireland had lower overall risk-adjusted mortality than those transplanted in the US (HR 0.88; 95% CI 0.81 to 0.96). This difference was observed among patients transplanted for chronic liver disease (HR 0.88; 95% CI 0.81 to 0.96), but not those transplanted for acute liver failure (HR 1.02; 95% CI 0.70 to 1.50). CONCLUSIONS: Whilst risk-adjusted mortality is higher in the UK and Ireland during the first 90 days following liver transplantation, it is higher in the US among those liver transplant recipients who survived the first post-transplant year. Our results are consistent with the notion that the US has superior acute perioperative care whereas the UK appears to provide better quality chronic care following liver transplantation surgery.
Authors: David A Axelrod; Mary K Guidinger; Keith P McCullough; Alan B Leichtman; Jeffrey D Punch; Robert M Merion Journal: Am J Transplant Date: 2004-06 Impact factor: 8.086
Authors: K V Narayanan Menon; Scott L Nyberg; William S Harmsen; Nelson F DeSouza; Charles B Rosen; Ruud A F Krom; Russell H Wiesner Journal: Am J Transplant Date: 2004-05 Impact factor: 8.086
Authors: David M Dickinson; Paula C Bryant; M Christian Williams; Gregory N Levine; Shiqian Li; James C Welch; Berkeley M Keck; Randall L Webb Journal: Am J Transplant Date: 2004 Impact factor: 8.086
Authors: Mathew Jacob; Lynn P Copley; James D Lewsey; Alex Gimson; Giles J Toogood; Mohamed Rela; Jan H P van der Meulen Journal: Liver Transpl Date: 2004-07 Impact factor: 5.799
Authors: Walter K Kremers; Marrije van IJperen; W Ray Kim; Richard B Freeman; Ann M Harper; Patrick S Kamath; Russell H Wiesner Journal: Hepatology Date: 2004-03 Impact factor: 17.425
Authors: Abhaya V Kulkarni; Benjamin C Warf; James M Drake; Conor L Mallucci; Spyros Sgouros; Shlomi Constantini Journal: Childs Nerv Syst Date: 2010-06-16 Impact factor: 1.475
Authors: Ennio Tasciotti; Fernando J Cabrera; Michael Evangelopoulos; Jonathan O Martinez; Usha R Thekkedath; Malgorzata Kloc; Rafik M Ghobrial; Xian C Li; Alessandro Grattoni; Mauro Ferrari Journal: Transplantation Date: 2016-08 Impact factor: 4.939
Authors: Chutwichai Tovikkai; Susan C Charman; Raaj K Praseedom; Alexander E Gimson; Jan van der Meulen Journal: BMJ Open Date: 2015-05-14 Impact factor: 2.692
Authors: Zhi Qu; Jill Gwiasda; Harald Schrem; Alexander Kaltenborn; Lena Harries; Jan Beneke; Volker Amelung; Christian Krauth Journal: BMJ Open Date: 2018-06-30 Impact factor: 2.692