Excellent outcome quality is not dependent on a high caseload in liver transplantation
Daniela Kniepeiss1, Derar Jaradat1, Masa Kusar1, Wolfgang Toller1, Helmut Müller1, Peter Schemmer1.
1General, Visceral and Transplant Surgery, Medical University Graz, Graz, Austria
Background: Today’s dogma without clear evidence is that case volume correlates with patients’ outcome after liver transplantation (LT). Thus, we prospectively analyzed the outcomes in our low volume center, which is characterized with strong interdisciplinary and interprofessional concepts.
Methods: Our LT program was re-organized and re-structured in 2016 including a center-embedded interdisciplinary and interprofessional team concept with new clinical standards for the peri-, intraoperative and follow-up management of patients. In parallel, routine pre-transplant histopathological evaluation of donor organs was established. Outcomes of 166 adult LTs (125 male; median age of 55.4 years [19 to 74 years]) performed between November 2016 and November 2021 was documented in a prospective database driven manner and compared with high volume centers. Kaplan-Meier method was used for long-term patient and graft survival.
Results: 1- / 5-years patient and graft survival was 95.3% / 91.8% and 82.7% and 78.4%, respectively. The median ICU stay was 2 days [1-125 days] and the median hospital stay was 15 days [7-187 days]. Hospital readmissions were necessary within the first 30 days and 1 year after discharge in 8% and 16% of cases, respectively.
Conclusion: Clearly defined standards developed within an interdisciplinary and interprofessional team concept result in best possible outcome quality of treatment after LT independent of caseload.
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