Survival after liver transplantation in the United Kingdom and Ireland compared with the United States
- 1Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
- 2Hepatobiliary 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;
- Revised 1 February 2007
- Accepted 28 February 2007
- Published Online First 13 March 2007
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.
Funding: The UK and Ireland Liver Transplant Audit is funded by the National Specialist Commissioning Advisory Group (NSCAG) of the Department of Health, London, UK. NSCAG had no role in the design and conduct of the study; the collection, management, analysis and interpretation of the data; or the preparation, review or approval of the manuscript. J H P van der Meulen is supported by a National Public Health Career Scientist Award, Department of Health - NHS R&D, UK.
Conflict of interest statement: None.
- hazard ratio
- international normalised ratio
- model for end-stage liver disease
- Organ Procurement and Transplantation Network/United Network for Organ Sharing