Journal article
Variation in Biliary Complication Rates Following Liver Transplantation: Implications for Cost and Outcome
American journal of transplantation, Vol.15(1), pp.170-179
01/01/2015
DOI: 10.1111/ajt.12970
PMID: 25534447
Abstract
Although biliary complications (BCs) have a significant impact on the outcome of liver transplantation (LT), variation in BC rates among transplant centers has not been previously analyzed. BC rate, LT outcome and spending were assessed using linked Scientific Registry of Transplant Recipients and Medicare claims (n=16286 LTs). Transplant centers were assigned to BC quartiles based upon risk-adjusted observed to expected (O:E) ratio of BC separately for donation after brain death (DBD) and donation after cardiac death (DCD) donors. The median incidence of BC was 300% greater in the highest versus lowest DBD quartiles (19.0% vs. 5.9%) and varied 250% between DCD quartiles (20.3%-8.4%). Donor and recipient characteristics suggest that high BC centers actually used lower donor risk index organs, fewer split livers and fewer imports (p<0.001 for all). Transplant at a center in the highest O:E quartile was associated with increased posttransplant mortality (adjusted hazard ratio [aHR] 2.53, p=0.007) in DCD transplant and increased graft loss (aHR 1.21, p=0.02) in DBD transplant. Medicare spending was $22895 (p<0.0001) higher at centers in highest versus lowest BC quartile. In summary, BC rates vary widely among transplant centers and higher rates are a marker for an increased risk of death, graft failure and health-care spending.
The incidence of biliary complications following liver transplant varies substantially between transplant programs and is associated with higher overall rates of death and graft loss.
Details
- Title: Subtitle
- Variation in Biliary Complication Rates Following Liver Transplantation: Implications for Cost and Outcome
- Creators
- D. A. Axelrod - Dartmouth–Hitchcock Medical CenterN. Dzebisashvili - Dartmouth–Hitchcock Medical CenterK. L. Lentine - St Louis Univ, Ctr Outcome Res, St Louis, MO 63103 USAH. Xiao - Saint Louis UniversityM. Schnitzler - Saint Louis UniversityJ. E. Tuttle-Newhall - Department of SurgerySaint Louis UniversitySt. LouisMOD. L. Segev - Saint Louis University
- Resource Type
- Journal article
- Publication Details
- American journal of transplantation, Vol.15(1), pp.170-179
- Publisher
- Wiley
- DOI
- 10.1111/ajt.12970
- PMID
- 25534447
- ISSN
- 1600-6135
- eISSN
- 1600-6143
- Number of pages
- 10
- Grant note
- Hitchcock Foundation RC1 1RC1DK086450-01 / American Recovery and Reinvestment Act grant from National Institute of Diabetes Digestive and Kidney Diseases RC1DK086450 / NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)
- Language
- English
- Date published
- 01/01/2015
- Academic Unit
- Surgery
- Record Identifier
- 9984322949402771
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