Ann Liver Transplant.  2022 May;2(1):8-14. 10.52604/alt.22.0011.

Association between institutional liver transplantation cases volume and mortality: A meta-analysis of Korea-nationwide cohort studies using Korean National Healthcare Insurance Service database

• Chung YK
• Park CS
• Kang SH

• KMID: 2560875
• DOI: http://doi.org/10.52604/alt.22.0011

Abstract

Institutional case volume of liver transplantation (LT) is reported to be not associated with post-transplant survival in the United States, but their association was presented in several Korea-nationwide studies. Considering that the majority of LT centers in Korea are classified as low-volume centers, it is necessary to evaluate the effect of institutional LT case volume on post-transplant outcomes through a meta-analysis. This meta-analysis included four Korea-nationwide cohort studies using the database of Korean National Healthcare Insurance Service (NHIS) that focused on adult deceased donor liver transplantation (DDLT), adult living donor liver transplantation (LDLT), pediatric LT, and liver re-transplantation. A total of 1,616 LT cases were performed in 56 centers in the year 2020. DDLT and LDLT were performed in 46 and 51 centers, respectively. A total of 2,648 adult DDLTs were performed at 54 centers. Centers were divided into high (>30 LTs/year)-, medium (10–30)-, and low (<10)-volume centers; and their in-hospital mortality (IHM) rates were 10.3%, 14.3%, and 17.1%, respectively. A total of 7,073 adult LDLTs were performed at 50 centers. Centers were divided into high (>50)-, medium (10-50)-, and low (<10)-volume centers; and their IHM rates were 2.8%, 4.1%, and 6.7%, respectively. A total of 521 pediatric LTs were performed at 22 centers. Centers were divided into high (>10)-, medium (1–10)-, and low (<1)-volume centers; and their IHM rates were 5.8%, 12.5%, and 32.1%, respectively. A total of 258 liver re-transplantation were performed; 175 cases were performed in 3 high-volume (≥64) centers and 83 cases were performed in 21 low-volume (<64) centers; and their IHM rates were 25% and 36%, respectively. The results of the present meta-analysis revealed the lower IHM rates in high-volume LT centers compared with low-volume centers regarding all types of LT including DDLT, adult LDLT, pediatric LT, and liver re-transplantation.

Keyword

Deceased donor liver transplantation; Living donor liver transplantation; Pediatric liver transplantation; Liver retransplantation; Mortality

Figure

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  Figure 1 Distribution of Korean transplantation centers performing deceased donor liver transplantations (DDLT) and living donor liver transplantations (LDLT) in 2020. LT, liver transplantation.

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  Figure 2 Relationship between the average annual number of deceased donor liver transplantation (DDLT) and in-hospital mortality at 54 centers, from 2007 to 2016. High-volume center: >30 liver transplantations (LTs)/year, Medium-volume center: 10–30 LTs/year, Low-volume center: <10 LTs/year.

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  Figure 3 Kaplan-Meier survival curve after adult deceased donor liver transplantation (DDLT) according to the center case volume.

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  Figure 4 Relationship between the average annual volume and in-hospital mortality after adult living donor liver transplantation. High-volume center: >50 liver transplantations (LTs)/year, Medium-volume center: 10–50 LTs/year, Low-volume center: <10 LTs/year.

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  Figure 5 Kaplan-Meier survival curve after adult living donor liver transplantation according to the center case volume.

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  Figure 6 Average annual case volume and in-hospital mortality after pediatric liver transplantation (LT). High-volume center: >10 LTs/year, Medium-volume center: 1–10 LTs/year, Low-volume center: <1 LTs/year.

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  Figure 7 Kaplan-Meier survival curve after pediatric liver transplantation (LT) according to the center case volume.

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  Figure 8 Relation between the institutional cases volume and in-hospital mortality after liver re-transplantation. High-volume center: ≥64 LTs/year, Low-volume center: <64 LTs/year. LT, liver transplantation.

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  Figure 9 Kaplan-Meier survival curve after liver re-transplantation according to the center case volume. LT, liver transplantation.

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  Figure 10 Fig. 10 . Forest plot of four Korea-nationwide cohort studies on LT. DDLT, deceased donor liver transplantation; LDLT, living donor liver transplantation; LT, liver transplantation; RR, relative risk; CI, confidence interval.

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