Korean J Transplant.  2022 Nov;36(Supple 1):S270. 10.4285/ATW2022.F-4086.

Proposal of a network system to solve the problem of small volume in liver transplantation: Catholic Medical Center network

• Choi Y
• Choi HJ
• You YK
• Hong TH
• Woo Y
• Park H
• Jun J

• KMID: 2535497
• DOI: http://doi.org/10.4285/ATW2022.F-4086

Abstract

Background
Liver transplantation (LT) is a challenging procedure that is associated with high perioperative morbidity and mortality, due to patient comorbidities and technical demands of the procedure. There are concerns about the outcomes of LT at a low-volume center. In the medical network of the Catholic Medical Center, we tried to make up these concerns through an integrated training and surgical team network. In this study, we reviewed 9 years of LT experience in the medical network of the Catholic Medical Center .
Methods
We performed a retrospective study of LT procedures performed from January 2013 through August 2021 in six hospitals of Catholic Medical Center. One medical center was categorized as high volume by mean annual volume over 60 cases per year. This study compared the results of one high-volume hospital and the results of five small-volume hospitals. The primary endpoint were 1-year survival and 5-year survival. A subgroup analysis was conducted after June 2016 when the Model of Endstage Liver Disease score was applied.
Results
A total of 793 LT were performed during the study period. In the high-volume center, 411 living donor LT (LDLT) cases were performed and 127 deceased donor LT (DDLT) were performed. Also, 146 LDLT cases and 109 DDLT cases were performed in five small-volume center. One-year and 5-year patient survival for LDLT patients was 88.3% and 78.8%, respectively, in high-volume center, and 85.6% and 80.6%, respectively, in low-volume center. Five-year survival was not significantly different in small-volume centers (P=0.903). For DDLT, 1-year and 5-year patient survival was 80.3% and 70.6%, respectively, in high-vol-ume center, and 76.1% and 67.6%, respectively, in low-volume center. In DDLT cases, 5-year survival was not significantly differ-ent in small-volume centers (P=0.445), either.
Conclusions
In conclusion, comparable outcome for LT can be obtained in a small volume center with a high level of integrated training systems and networks.