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

作     者：Rohan M Modi Dmitry Tumin Andrew J Kruger Eliza W Beal Don Hayes Jr James Hanje Anthony J Michaels Kenneth Washburn Lanla F Conteh Sylvester M Black Khalid Mumtaz 

作者机构：Department of Internal MedicineOhio State University Wexner Medical CenterColumbusOH 43210United States Department of Anesthesiology and Pain MedicineNationwide Children’s HospitalColumbusOH 43205United States Department of General SurgeryDivision of TransplantationOhio State University Wexner Medical CenterColumbusOH 43210United States Comprehensive Transplant CenterOhio State University Wexner Medical CenterColumbusOH 43210United States Section of Pulmonary MedicineNationwide Children’s HospitalColumbusOH 43205United States Department of Internal MedicineDivision of GastroenterologyHepatology and NutritionOhio State University Wexner Medical CenterColumbusOH 43210United States 

出 版 物：《World Journal of Hepatology》 (世界肝病学杂志（英文版）（电子版）)

年 卷 期：2018年第10卷第1期

页      面：134-141页

学科分类：10[医学] 

主　　题：Kidney transplantation Center volume Mortality Liver transplantation United network for organ sharing 

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 *** 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 *** 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 *** 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.