Effect of Surgeon Service Volume on Survival of Liver Transplant Patients: A Nationwide Cohort Study

Background/Objectives: Liver transplantation is an effective treatment for end-stage liver disease, and patients treated by surgeons with higher service volumes have better therapeutic outcomes. However, few studies have examined the effects of cumulative service volume on the survival of liver transplant patients. The objective of this study was to investigate the effect of a surgeon's cumulative service volume on the survival rates of liver transplant patients. Methods: The study was a retrospective and nationwide cohort study. Patients who underwent a liver transplant in 2005-2013 were identified. The data were from the Taiwan National Health Insurance Research Database. The primary outcome was the effect of surgeon service volume on 1-year survival after surgery for liver transplant patients. Results: A total of 3233 patients who underwent liver transplantation had a first-year survival rate of 85.8%. The high relative service volume group (>307 cases) had the highest patient survival rate at 1 year after operation (95.31%), while the low relative service volume group (<31 cases) had the lowest survival rate (71.39%). After relevant adjustment variables, the risk of mortality was significantly higher among patients operated on when their surgeons had accumulated fewer than 41 prior transplant cases, and the risk of mortality decreased as the cumulative service volume of surgeons rose. Conclusions: This nationwide cohort study demonstrated an association, rather than a causal relationship, between surgeon cumulative service volume and 1-year survival after liver transplantation. One-year survival reached approximately 85% once surgeons had accumulated 41-60 prior transplant cases. These findings may provide a reference for understanding the clinical learning curve in liver transplantation.