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Published on: August 13, 2014
Hospital Mortality and Current Trends in Liver Transplantation in Germany—a Systematic Analysis of Standardized
Sven H Loosen1, Hans H Bock, Martin Hellmich
1Department of Gastroenterology, Hepatology and Infectiology, Düsseldorf University Hospital, Medical Faculty of Heinrich Heine University Düsseldorf; Liver Transplant Society Aachen-Düsseldorf-Maastricht; Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne; Department for General Visceral and Pediatric Surgery, Düsseldorf University Hospital, Medical Faculty of the Heinrich Heine University Düsseldorf; Department of Medicine III, University Hospital RWTH Aachen; Department of Visceral and Transplant Surgery, University Hospital RWTH Aachen; Maastricht University Medical Centre+ (MUMC), Maastricht, Netherlands.
Background:
Liver transplantation (LT) has undergone dynamic developments in recent decades. In Germany, the Federal Joint Committee (G-BA) recently tightened the guidelines regarding the minimum number of transplantations a center should perform annually. The aim of the study presented here, was to analyze recent trends in hospital mortality due to LT in Germany.
Methods:
Standardized hospital discharge data (2008-2017) from the Federal Statistical Office of Germany were used to establish hospital mortality after LT and case volume distribution among centers performing <20 LT annually (low volume centers, LVC), 20-49 LT (medium volume centers, MVC), and ≥ 50 LT (high volume centers, HVC).
Results:
Data from 9254 LT procedures were evaluated. The annual frequency of LT fell from n = 984 (2008) to n = 747 (2017), and over the same period the hospital mortality for all LT procedures went down from 15.8% to 11.0%. Hospital mortality was associated with age (<16 years: 5.3% to 60-69 years: 17.4%); however, there was no further increase in patients ≥ 70 years (16.5%). Univariate analysis revealed association of increased hospital mortality with liver disease etiology, the necessity for relaparotomy, and prolonged mechanical ventilation. The proportion of LT procedures performed in LVC and MVC increased and that in HVC decreased. LVC had higher hospital mortality than MVC/HVC, but this effect was dependent on patient age and disease etiology.
Conclusion:
Our study showed that differences in mortality rate after LT among centers (LVC vs. MVC/HVC) were dependent on patient age and disease etiology. This should be taken into account when discussing the overall organization of LT in Germany.
