Liver

Survival after liver transplantation in the United Kingdom and Ireland compared with the United States

M F Dawwas², A E Gimson², J D Lewsey¹, L P Copley¹, J H P van der Meulen¹ on behalf of the UK and Ireland Liver Transplant Audit

¹ Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
² Hepatobiliary and Liver Transplant Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK

M F Dawwas, Hepatobiliary and Liver Transplant Unit, Box 210, Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ, UK; drdawwas{at}gmail.com

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.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Hirschfield, G M, Gibbs, P, Griffiths, W J H (2009). Adult liver transplantation: what non-specialists need to know. BMJ 338: b1670-b1670 [Full Text]  
• van der Hilst, C. S., IJtsma, A. J. C., Slooff, M. J. H., TenVergert, E. M. (2009). Cost of Liver Transplantation: A Systematic Review and Meta-Analysis Comparing the United States With Other OECD Countries. Med Care Res Rev 66: 3-22 [Abstract]  
• Langham, J., Reeves, B. C., Lindsay, K. W., van der Meulen, J. H., Kirkpatrick, P. J., Gholkar, A. R., Molyneux, A. J., Shaw, D. M., Copley, L., Browne, J. P., for the Steering Group for National Study of Subar, (2009). Variation in Outcome After Subarachnoid Hemorrhage: A Study of Neurosurgical Units in UK and Ireland. Stroke 40: 111-118 [Abstract] [Full Text]  
• Schemmer, P, Fischer, L, Schmidt, J, Buchler, M W (2007). Intercontinental comparison of patient cohorts: what can we learn from it?. Gut 56: 1500-1501 [Full Text]