[Evaluation of liver transplant quality in France]

The French Biomedecine Agency evaluated the outcomes of liver transplantation in France. The one-year graft failure rate in each transplant center was compared with the national rate, after adjusting for recipient, donor and transplant characteristics. All patients transplanted from 1998 to 2002 were included, except when a live donor was used. The validity and completeness of the data were first reviewed by the transplantation centers, and the quality of the database was audited by an independent contractor. The objectives, methodology and results of univariate analysis were discussed with the medical staff in each transplant center before the final analysis. The final statistical analysis used a multivariate logistic regression model including all predictive factors of the one-year graft failure rate. The adjusted failure rate was estimated for each transplant center and compared with the 99% confidence interval of the national failure rate. Twenty-four centres and 3625 transplantations were included. The national failure rate was 19%. Nineteen predictive factors were included in multivariate analysis of the one-year graft failure rate. Two centres were outside the 99% confidence interval of the national failure rate: one was significantly lower and one significantly higher. This study will be repeated each year in order to follow trends in the adjusted one-year failure rates in the different centers. The 3-year graft failure rate will also be studied in the same way. The Biomedecine Agency hopes that this work will encourage transplant centers to improve their quality of care.