Alqahtani Saleh A, Stepanova Maria, Kabbara Khaled W, Younossi Issah, Mishra Alita, Younossi Zobair
Center for Outcomes Research in Liver Diseases, Washington, DC.
Division of Gastroenterology & Hepatology, Johns Hopkins University, Baltimore, MD.
Transplantation. 2022 May 1;106(5):988-996. doi: 10.1097/TP.0000000000003915. Epub 2021 Aug 5.
Prior studies suggest that transplant center volume is associated with liver transplantation (LT) outcomes. We compared patient characteristics and waitlist outcomes among transplant centers in the United States with different volumes.
Data for adult waitlisted candidates and LT recipients in the United States between 2008 and 2017 were extracted from the Scientific Registry of Transplant Recipients database. Transplant centers were categorized by transplants/year into tertiles: low-volume centers (LVCs; <20 transplantations/y); medium-volume centers (MVCs; 20-55 transplantations/y); and high-volume centers (HVCs; >55 transplantations/y). Patient characteristics, waitlist outcomes, and factors associated with posttransplantation mortality were compared.
From 141 centers, 112 110 patients were waitlisted for LT: 6% at LVCs, 26% at MVCs, and 68% at HVCs. Patients listed at LVCs were less likely to have private insurance but had higher Medicaid and Veterans Affairs healthcare rates. Patients at LVCs were less likely to receive LT (47% versus 53% in MVC versus 61% in HVC), had higher transfer rates to other centers, and were more likely to be removed from the waitlist. In competing risk survival analysis, adjusted for center location, MELD score, and clinicodemographic factors, patients listed at an HVC were more likely to receive LT (adjusted hazard ratio:1.30; 95% confidence interval = 1.27-1.33; P < 0.001). Among LT recipients (n = 62 131), receiving a transplant at an LVC was associated with higher post-LT mortality (adjusted hazard ratio: 1.16; 95% confidence interval = 1.05-1.28; P = 0.003).
Patients at LVCs were less likely to receive a LT and had a higher risk of post-LT death.
先前的研究表明，移植中心的手术量与肝移植（LT）的结果相关。我们比较了美国不同手术量的移植中心的患者特征和等待名单结果。
从移植受者科学注册数据库中提取2008年至2017年美国成年等待名单上的候选者和LT受者的数据。移植中心按每年的移植手术量分为三分位数：低手术量中心（LVCs；每年<20例移植手术）；中等手术量中心（MVCs；每年20 - 55例移植手术）；高手术量中心（HVCs；每年>55例移植手术）。比较患者特征、等待名单结果以及与移植后死亡率相关的因素。
在141个中心中，有112110名患者被列入LT等待名单：LVCs为6%，MVCs为26%，HVCs为68%。在LVCs登记的患者拥有私人保险的可能性较小，但医疗补助和退伍军人事务医疗覆盖率较高。LVCs的患者接受LT的可能性较小（MVCs为53%，HVCs为61%，LVCs为47%），转至其他中心的比例较高，且更有可能从等待名单中被移除。在竞争风险生存分析中，经中心位置、终末期肝病模型（MELD）评分和临床人口统计学因素校正后，在HVC登记的患者接受LT的可能性更大（校正风险比：1.30；95%置信区间 = 1.27 - 1.33；P < 0.001）。在LT受者（n = 62131）中，在LVC接受移植与LT后较高的死亡率相关（校正风险比：1.16；95%置信区间 = 1.05 - 1.28；P = 0.003）。
LVCs的患者接受LT的可能性较小，且LT后死亡风险较高。
