Survival after liver transplantation in the United Kingdom and Ireland compared with the United States

Dawwas, M. F.; Gimson, A. E.; Lewsey, J. D.; Copley, L. P.; van der Meulen, J. H. P.
November 2007
Gut;Nov2007, Vol. 56 Issue 11, p1606
Academic Journal
Background and objective: Surgical mortality in the US is widely perceived to be superior to that in the UK. However, previous comparisons of surgical outcome in the two countries have often failed to take sufficient account of case-mix or examine long-term outcome. The standardised nature of liver transplantation practice makes it uniquely placed for undertaking reliable international comparisons of surgical outcome. The objective of this study is to undertake a risk-adjusted disease-specific comparison of both short- and long-term survival of liver transplant recipients in the UK and Ireland with that in the US. Methods: A multicentre cohort study using two high quality national databases including all adults who underwent a first single organ liver transplant in the UK and Ireland (n = 5925) and the US (n = 41 866) between March 1994 and March 2005. The main outcome measures were post-transplant mortality during the first 90 days, 90 days to 1 year and beyond the first year, adjusted for recipient and donor characteristics. Results: Risk-adjusted mortality in the UK and Ireland was generally higher than in the US during the first 90 days (HR 1.17; 95% CI 1.07 to 1.29), both for patients transplanted for acute liver failure (HR 1.27; 95% CI 1.01 to 1.60) and those transplanted for chronic liver disease (HR 1.18; 95% CI 1.07 to 1.31). Between 90 days and 1 year post-transplantation, no statistically significant differences in overall risk-adjusted mortality were noted between the two cohorts. Survivors of the first post-transplant year in the UK and Ireland had lower overall risk-adjusted mortality than those transplanted in the US (HR 0.88; 95% CI 0.81 to 0.96). This difference was observed among patients transplanted for chronic liver disease (HR 0.88; 95% CI 0.81 to 0.96), but not those transplanted for acute liver failure (HR 1.02; 95% CI 0.70 to 1.50). Conclusions: Whilst risk-adjusted mortality is higher in the UK and Ireland during the first 90 days following liver transplantation, it is higher in the US among those liver transplant recipients who survived the first post-transplant year. Our results are consistent with the notion that the US has superior acute perioperative care whereas the UK appears to provide better quality chronic care following liver transplantation surgery.


Related Articles

  • Techniques of liver transplantation. Fortner, Joseph G. // RN;May76, Vol. 39 Issue 5, pOR1 

    Discusses the techniques of liver transplantation. Ligation process of the bile duct; Information on anesthetic agents used in the transplantation; Details on the fluid replacement.

  • Left gastric artery as an alternative for arterial reconstruction in orthotopic liver... Mizrahi, Solly S.; Hayes, Daniel H. // American Surgeon;Sep1995, Vol. 61 Issue 9, p761 

    Proposes the use of the left gastric artery as an alternative for reconstructing the arterial blood supply. Importance of the hepatic arterial blood supply in liver transplantation; Inadequacies of recipient hepatic artery.

  • Successful liver transplantation in babies under 1 year. Beath, S.V.; Brook, G.D.; Kelly, D.A.; Cash, A.J.; McMaster, P.; Mayer, A.D.; Buckels, J.A.C. // BMJ: British Medical Journal (International Edition);10/2/93, Vol. 307 Issue 6908, p825 

    Examines the outcome of liver transplantation in babies in Birmingham, England. Complications of the transplantation; Death of two babies with fulminant hepatic failure; Improvement in growth of babies; Development of psychosocial behavior with good quality of life.

  • Liver transplantation: current status and future prospects. Strong, R.W. // Journal of the Royal College of Surgeons of Edinburgh;Feb2001, Vol. 46 Issue 1, p1 

    Focuses on the progress in liver transplantation. Increase in the number of living donor transplants; Alternatives to liver transplantation; Elimination of the factors causing graft failure and patient demise.

  • Recipient and donor thrombophilia and the risk of portal venous thrombosis and hepatic artery thrombosis in liver recipients.  // BMC Gastroenterology;2011, Vol. 11 Issue 1, p130 

    The article focuses on a study which aims to characterize post-transplant thrombotic events in a cohort of liver transplant recipients, and identify independent risk factors for these complications. As mentioned, a thrombophilic study was conducted, of 293 orthotopic liver transplants performed...

  • Perfusion by pig. HLN // Hastings Center Report;Mar/Apr93, Vol. 23 Issue 2, p4 

    Relates the a case of vein-to-vein xenoperfusion, using pig livers, on a twenty-two-year-old man prior to a liver transplant. Succession of five pig livers; A different xenoperfusion technique by Johns Hopkins researchers.

  • Living Donor Liver Transplantation with Special Reference to ABO-incompatible Grafts and Small-for-size Grafts. Motohide Shimazu; Masaki Kitajima // World Journal of Surgery;Jan2004, Vol. 28 Issue 1, p2 

    Living donor liver transplantation (LDLT) has developed on the basis of increased safety of conventional liver surgery and the need for expanding donor sources, especially in children. Indications for LDLT were soon extended to adult patients in Japan, where cadaveric donation was limited. The...

  • To Shunt or Not to Shunt in the Era of Liver Transplantation? Thompson, Jon S. // American Journal of Gastroenterology;Apr1998, Vol. 93 Issue 4, p503 

    Discusses research being done on shunt surgery during the era of liver transplantation. Reference to a study by L. F. Rikkers et al published in a 1997 issue of "Annals of Surgery"; Number of patients involved in the study; Percentage of the patients who died during follow up.

  • Liver transplantation in children: long-term outcome and quality of life. Burdelski, M.; Nolkemper, D.; Ganschow, R.; Sturm, E.; Malago, M.; Rogiers, X.; Br´┐Żlsch, C. E. // European Journal of Pediatrics;1999, Vol. 158 Issue 14, pS034 

    Abstract Liver transplantation has become a standard therapy in acute and chronic liver failure. Since 1968, 2554 paediatric patients receiving a liver transplant have been registered in the European Liver Transplant Registry (ELTR). Compared with 22,600 total transplants registered in the ELTR...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics