Effect of transplant center volume on post-transplant survival in patients listed for simultaneous liver and kidney transplantation

• 作者: Andrew J Kruger Anthony J Michaels Dmitry Tumin Don Hayes Jr Eliza W Beal James Hanje Kenneth Washburn Khalid Mumtaz Lanla F Conteh Rohan M Modi Sylvester M Black
• 来源期刊: 世界肝病学杂志：英文版（电子版）
• 学科: 医学
• 关键词: Kidney TRANSPLANTATION CENTER VOLUME Mortality Liver TRANSPLANTATION UNITED network for organ sharing
• 年，卷（期）: 2018,（1）
• 页码范围: 134-141
• 页数: 8页
• 分类号: R

摘要

AIM To examine the effect of center size on survival differences between simultaneous liver kidney transplantation(SLKT)and liver transplantation alone(LTA)in SLKT-listed patients.METHODS The United Network of Organ Sharing database was queried for patients≥18 years of age listed for SLKT between February 2002 and December 2015.Posttransplant survival was evaluated using stratified Cox regression with interaction between transplant type(LTA vs SLKT)and center volume.RESULTS During the study period,393 of 4580 patients(9%)listed for SLKT underwent a LTA.Overall mortality was higher among LTA recipients(180/393,46%)than SLKT recipients(1107/4187,26%).The Cox model predicted a significant survival disadvantage for patients receiving LTA vs SLKT[hazard ratio,hazard ratio(HR)=2.85;95%CI:2.21,3.66;P<0.001]in centers performing 30 SLKT over the study period.This disadvantage was modestly attenuated as center SLKT volume increased,with a 3%reduction(HR=0.97;95%CI:0.95,0.99;P=0.010)for every 10 SLKs performed.CONCLUSION In conclusion,LTA is associated with increased mortality among patients listed for SLKT.This difference is modestly attenuated at more experienced centers and may explain inconsistencies between smaller-center and larger registry-wide studies comparing SLKT and LTA outcomes.