Novel benchmark values for redo liver transplantation – does the outcome justify the effort?

医学 水准点(测量) 肝移植 移植 重症监护室 百分位 外科 经济短缺 内科学 统计 大地测量学 数学 语言学 哲学 地理 政府(语言学)
作者
Fariba Abbassi,Dániel Gerö,Xavier Muller,Alba Bueno,Wojciech Figiel,F Robin,Sophie Laroche,Bertrand Picard,Sadhana Shankar,Tommy Ivanics,Marjolein van Reeven,Otto B. van Leeuwen,Hillary J. Braun,Diethard Monbaliu,Antoine Breton,Neeta Vachharajani,E Bonaccorsi Riani,G. Nowak,Robert McMillan,Samir Abu‐Gazala,Amit Nair,R Bruballa,Flavio Paterno,Deborah Weppler Sears,Antonio D. Pinna,James V. Guarrera,Eduardo de Santibañés,Martín de Santibañes,R Hernandez-Aleja,Kimberly Olthoff,Rafik M. Ghobrial,B-G Ericzon,O Ciccarelli,Will Chapman,J.‐Y. Mabrut,Jacques Pirenne,Beat Müllhaupt,Nancy L. Ascher,Robert J. Porte,V E de Meier,Wojciech Polak,Gonzalo Sapisochín,M. Attia,Emmanuel Weiss,Rene Adam,Daniel Cherqui,K Boudjema,K Zienewicz,Wayel Jassem,Milo A. Puhan,Philipp Dutkowski,P.‐A. Clavien
出处
期刊:British Journal of Surgery [Oxford University Press]
卷期号:109 (Supplement_3)
标识
DOI:10.1093/bjs/znac178.001
摘要

Abstract Objective In the era of organ shortage, redo liver transplantation (reLT) is frequently discussed in terms of expected poor outcome, high cost and therefore wasteful resources. However, there is a lack of benchmark data to reliably assess outcomes after reLT. The aim of this study was to define the ideal reLT case, and to establish clinically relevant benchmark values for best achievable outcome in reLT. Methods We collected data on reLT between January 2010 and December 2018 from 22 high volume transplant centers on three continents. Benchmark cases were defined as recipients with model of end-stage liver disease score <=25, absence of portal vein thrombosis, no mechanical ventilation before surgery, receiving a graft from a donor after brain death. In addition, early reLT including those for primary non-function (PNF) were excluded. Clinically relevant endpoints covering intra- and postoperative course were selected and complications were graded by severity using the Clavien-Dindo classification and the comprehensive complication index (CCI). The benchmark cutoff for each outcome was derived from the 75th percentile of the median values of all benchmark centers, indicating the “best achievable” result. To assess the utility of the newly established benchmark values, we analyzed patients who received reLT for PNF (non-benchmark patients). Results Out of 1110 reLT 413 (37.2%) qualified as benchmark cases. Benchmark values included: Length of intensive care unit and hospital stay: <=6 and <=24 days, respectively; Clavien-Dindo grade >=3a complications and the CCI at 1 year: <=76% and <=72.2, respectively; in-hospital and 1-year mortality rates: <=14.0% and <=14.3%, respectively. The cutoffs for transplant-specific complications such as biliary complications at 1 year, outflow problems at 1 year and hepatic artery thrombosis at discharge were <=27.3%, <=2.5% and <=4.8%, respectively. Patients receiving a reLT for PNF showed mean outcome values all outside the reLT benchmark values. In-hospital mortality rate was 34.4% and the mean CCI at discharge 68.8. Conclusion ReLT remains associated with high morbidity and mortality. The availability of benchmark values for outcome parameters of reLT may serve for comparison in any future analyses of individuals, patient groups, or centers, but also in the evaluation of new therapeutic strategies and principles.

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