Xavier Muller1, Francesca Marcon2, Gonzalo Sapisochin3, Max Marquez3, Federica Dondero4, Michel Rayar5, Majella M B Doyle6, Lauren Callans7, Jun Li8, Greg Nowak9, Marc-Antoine Allard10, Ina Jochmans11, Kyle Jacskon12, Magali Chahdi Beltrame13, Marjolein van Reeven14, Samuele Iesari15, Alessandro Cucchetti16, Hemant Sharma17,18, Roxane D Staiger1, Dimitri A Raptis1, Henrik Petrowsky1, Michelle de Oliveira1, Roberto Hernandez-Alejandro17,18, Antonio D Pinna16, Jan Lerut15, Wojciech G Polak14, Eduardo de Santibañes13, Martín de Santibañes13, Andrew M Cameron12, Jacques Pirenne11, Daniel Cherqui10, René A Adam10, Bö-Göran Ericzon9, Bjoern Nashan8, Kim Olthoff7, Avi Shaked7, William C Chapman6, Karim Boudjema5, Olivier Soubrane4, Catherine Paugam-Burtz4, Paul D Greig3, David R Grant3, Amanda Carvalheiro2, Paolo Muiesan2, Philipp Dutkowski1, Milo Puhan19, Pierre-Alain Clavien1. 1. Department of Surgery and Transplantation, Swiss HPB Center Zurich, University Hospital Zurich, Zurich, Switzerland. 2. Department of HBP Surgery and Transplantation, Queen Elizabeth Hospital and Birmingham Children's Hospital, Birmingham, UK. 3. Department of Surgery, Abdominal Transplant and HPB Surgical Oncology, Toronto General Hospital, University of Toronto, Toronto, ON, Canada. 4. Department of Surgery and Transplantation, Hôpital Beaujon, Clichy, France. 5. Department of HBP Surgery and Transplantation, University Hospital Rennes, Rennes, France. 6. Division of General Surgery and Section of Abdominal Transplantation, Washington University School of Medicine, St. Louis, MO. 7. Division of Transplantation, University of Pennsylvania, Philadelphia, PA. 8. Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 9. Division of Transplantation Surgery, CLINTEC Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden. 10. Department of Surgery, The Hepatobilairy Center, Paul Brousse Hospital, University Paris Sud, Villejuif, France. 11. Abdominal Transplant Surgery, KU Leuven, University Hospitals Leuven, Leuven, Belgium. 12. Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD. 13. Division of HBP Surgery, Department of Surgery, Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina. 14. Department of Surgery and Transplantation, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands. 15. Department of Abdominal and Transplant Surgery, University Hospital St. Luc, Brussels, Belgium. 16. Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. 17. Division of Transplantation, University of Rochester Medical Center, New York, NY. 18. Department of Surgery, Western University, London, ON, Canada. 19. Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Abstract
: This multicentric study of 17 high-volume centers presents 12 benchmark values for liver transplantation. Those values, mostly targeting markers of morbidity, were gathered from 2024 "low risk" cases, and may serve as reference to assess outcome of single or any groups of patients. OBJECTIVE: To propose benchmark outcome values in liver transplantation, serving as reference for assessing individual patients or any other patient groups. BACKGROUND: Best achievable results in liver transplantation, that is, benchmarks, are unknown. Consequently, outcome comparisons within or across centers over time remain speculative. METHODS: Out of 7492 liver transplantation performed in 17 international centers from 3 continents, we identified 2024 low risk adult cases with a laboratory model for end-stage liver disease score ≤20 points, a balance of risk score ≤9, and receiving a primary graft by donation after brain death. We chose clinically relevant endpoints covering intra- and postoperative course, with a focus on complications graded by severity including the complication comprehensive index (CCI). Respective benchmarks were derived from the median value in each center, and the 75 percentile was considered the benchmark cutoff. RESULTS: Benchmark cases represented 8% to 49% of cases per center. One-year patient-survival was 91.6% with 3.5% retransplantations. Eighty-two percent of patients developed at least 1 complication during 1-year follow-up. Biliary complications occurred in one-fifth of the patients up to 6 months after surgery. Benchmark cutoffs were ≤4 days for ICU stay, ≤18 days for hospital stay, ≤59% for patients with severe complications (≥ Grade III) and ≤42.1 for 1-year CCI. Comparisons with the next higher risk group (model for end stage liver disease 21-30) disclosed an increase in morbidity but within benchmark cutoffs for most, but not all indicators, while in patients receiving a second graft from 1 center (n = 50) outcome values were all outside of benchmark values. CONCLUSIONS: Despite excellent 1-year survival, morbidity in benchmark cases remains high with half of patients developing severe complications during 1-year follow-up. Benchmark cutoffs targeting morbidity parameters offer a valid tool to assess higher risk groups.
: This multicentric study of 17 high-volume centers presents 12 benchmark values for liver transplantation. Those values, mostly targeting markers of morbidity, were gathered from 2024 "low risk" cases, and may serve as reference to assess outcome of single or any groups of patients. OBJECTIVE: To propose benchmark outcome values in liver transplantation, serving as reference for assessing individual patients or any other patient groups. BACKGROUND: Best achievable results in liver transplantation, that is, benchmarks, are unknown. Consequently, outcome comparisons within or across centers over time remain speculative. METHODS: Out of 7492 liver transplantation performed in 17 international centers from 3 continents, we identified 2024 low risk adult cases with a laboratory model for end-stage liver disease score ≤20 points, a balance of risk score ≤9, and receiving a primary graft by donation after brain death. We chose clinically relevant endpoints covering intra- and postoperative course, with a focus on complications graded by severity including the complication comprehensive index (CCI). Respective benchmarks were derived from the median value in each center, and the 75 percentile was considered the benchmark cutoff. RESULTS: Benchmark cases represented 8% to 49% of cases per center. One-year patient-survival was 91.6% with 3.5% retransplantations. Eighty-two percent of patients developed at least 1 complication during 1-year follow-up. Biliary complications occurred in one-fifth of the patients up to 6 months after surgery. Benchmark cutoffs were ≤4 days for ICU stay, ≤18 days for hospital stay, ≤59% for patients with severe complications (≥ Grade III) and ≤42.1 for 1-year CCI. Comparisons with the next higher risk group (model for end stage liver disease 21-30) disclosed an increase in morbidity but within benchmark cutoffs for most, but not all indicators, while in patients receiving a second graft from 1 center (n = 50) outcome values were all outside of benchmark values. CONCLUSIONS: Despite excellent 1-year survival, morbidity in benchmark cases remains high with half of patients developing severe complications during 1-year follow-up. Benchmark cutoffs targeting morbidity parameters offer a valid tool to assess higher risk groups.
Authors: Víctor Lopez-Lopez; Juan José Ruiz-Manzanera; Dilmurodjon Eshmuminov; Kuno Lehmann; Marcel Schneider; Markus von der Groeben; David Ruiz de Angulo; Ursula Gajownik; Jose Antonio Pons; Francisco Sánchez-Bueno; Ricardo Robles-Campos; Pablo Ramírez-Romero Journal: Obes Surg Date: 2020-11-23 Impact factor: 4.129
Authors: Jennifer C Lai; Dorry L Segev; Charles E McCulloch; Kenneth E Covinsky; Jennifer L Dodge; Sandy Feng Journal: Am J Transplant Date: 2018-03-13 Impact factor: 8.086
Authors: Bandar Al-Judaibi; M Katherine Dokus; Waleed Al-Hamoudi; Dieter Broering; Mohammad Mawardi; Nasser AlMasri; Mohammed Aljawad; Ibrahim H Altraif; Faisal Abaalkhail; Saleh A Alqahtani Journal: Saudi J Gastroenterol Date: 2022 Mar-Apr Impact factor: 2.485