Defining Benchmarks in Liver Transplantation: A Multicenter Outcome Analysis Determining Best Achievable Results

Xavier Muller, Francesca Marcon, Gonzalo Sapisochin, Max Marquez, Federica Dondero, Michel Rayar, Majella M.B. Doyle, Lauren Callans, Jun Li, Greg Nowak, Marc Antoine Allard, Ina Jochmans, Kyle Jacskon, Magali Chahdi Beltrame, Marjolein Van Reeven, Samuele Iesari, Alessandro Cucchetti, Hemant Sharma, Roxane D. Staiger, Dimitri A. RaptisHenrik Petrowsky, Michelle De Oliveira, Roberto Hernandez-Alejandro, Antonio D. Pinna, Jan Lerut, Wojciech G. Polak, Eduardo De Santibañes, Martín De Santibañes, Andrew M Cameron, Jacques Pirenne, Daniel Cherqui, René A. Adam, Bö Göran Ericzon, Bjoern Nashan, Kim Olthoff, Avi Shaked, William C. Chapman, Karim Boudjema, Olivier Soubrane, Catherine Paugam-Burtz, Paul D. Greig, David R. Grant, Amanda Carvalheiro, Paolo Muiesan, Philipp Dutkowski, Milo Puhan, Pierre Alain Clavien

Research output: Contribution to journalArticle

Abstract

Objective: To propose benchmark outcome values in liver transplantation, serving as reference for assessing individual patients or any other patient groups. Background: Best achievable results in liver transplantation, that is, benchmarks, are unknown. Consequently, outcome comparisons within or across centers over time remain speculative. Methods: Out of 7492 liver transplantation performed in 17 international centers from 3 continents, we identified 2024 low risk adult cases with a laboratory model for end-stage liver disease score ≤20 points, a balance of risk score ≤9, and receiving a primary graft by donation after brain death. We chose clinically relevant endpoints covering intra- and postoperative course, with a focus on complications graded by severity including the complication comprehensive index (CCI ®). Respective benchmarks were derived from the median value in each center, and the 75 percentile was considered the benchmark cutoff. Results: Benchmark cases represented 8% to 49% of cases per center. One-year patient-survival was 91.6% with 3.5% retransplantations. Eighty-two percent of patients developed at least 1 complication during 1-year follow-up. Biliary complications occurred in one-fifth of the patients up to 6 months after surgery. Benchmark cutoffs were ≤4 days for ICU stay, ≤18 days for hospital stay, ≤59% for patients with severe complications (≥ Grade III) and ≤42.1 for 1-year CCI ®. Comparisons with the next higher risk group (model for end stage liver disease 21-30) disclosed an increase in morbidity but within benchmark cutoffs for most, but not all indicators, while in patients receiving a second graft from 1 center (n = 50) outcome values were all outside of benchmark values. Conclusions: Despite excellent 1-year survival, morbidity in benchmark cases remains high with half of patients developing severe complications during 1-year follow-up. Benchmark cutoffs targeting morbidity parameters offer a valid tool to assess higher risk groups.

Original languageEnglish (US)
Pages (from-to)419-425
Number of pages7
JournalAnnals of Surgery
Volume267
Issue number3
DOIs
StatePublished - Mar 1 2018

Fingerprint

Benchmarking
Liver Transplantation
End Stage Liver Disease
Morbidity
Transplants
Brain Death
Survival
Length of Stay

Keywords

  • benchmark
  • complication
  • liver transplantation
  • morbidity
  • outcome

ASJC Scopus subject areas

  • Surgery

Cite this

Muller, X., Marcon, F., Sapisochin, G., Marquez, M., Dondero, F., Rayar, M., ... Clavien, P. A. (2018). Defining Benchmarks in Liver Transplantation: A Multicenter Outcome Analysis Determining Best Achievable Results. Annals of Surgery, 267(3), 419-425. https://doi.org/10.1097/SLA.0000000000002477

Defining Benchmarks in Liver Transplantation : A Multicenter Outcome Analysis Determining Best Achievable Results. / Muller, Xavier; Marcon, Francesca; Sapisochin, Gonzalo; Marquez, Max; Dondero, Federica; Rayar, Michel; Doyle, Majella M.B.; Callans, Lauren; Li, Jun; Nowak, Greg; Allard, Marc Antoine; Jochmans, Ina; Jacskon, Kyle; Beltrame, Magali Chahdi; Van Reeven, Marjolein; Iesari, Samuele; Cucchetti, Alessandro; Sharma, Hemant; Staiger, Roxane D.; Raptis, Dimitri A.; Petrowsky, Henrik; De Oliveira, Michelle; Hernandez-Alejandro, Roberto; Pinna, Antonio D.; Lerut, Jan; Polak, Wojciech G.; De Santibañes, Eduardo; De Santibañes, Martín; Cameron, Andrew M; Pirenne, Jacques; Cherqui, Daniel; Adam, René A.; Ericzon, Bö Göran; Nashan, Bjoern; Olthoff, Kim; Shaked, Avi; Chapman, William C.; Boudjema, Karim; Soubrane, Olivier; Paugam-Burtz, Catherine; Greig, Paul D.; Grant, David R.; Carvalheiro, Amanda; Muiesan, Paolo; Dutkowski, Philipp; Puhan, Milo; Clavien, Pierre Alain.

In: Annals of Surgery, Vol. 267, No. 3, 01.03.2018, p. 419-425.

Research output: Contribution to journalArticle

Muller, X, Marcon, F, Sapisochin, G, Marquez, M, Dondero, F, Rayar, M, Doyle, MMB, Callans, L, Li, J, Nowak, G, Allard, MA, Jochmans, I, Jacskon, K, Beltrame, MC, Van Reeven, M, Iesari, S, Cucchetti, A, Sharma, H, Staiger, RD, Raptis, DA, Petrowsky, H, De Oliveira, M, Hernandez-Alejandro, R, Pinna, AD, Lerut, J, Polak, WG, De Santibañes, E, De Santibañes, M, Cameron, AM, Pirenne, J, Cherqui, D, Adam, RA, Ericzon, BG, Nashan, B, Olthoff, K, Shaked, A, Chapman, WC, Boudjema, K, Soubrane, O, Paugam-Burtz, C, Greig, PD, Grant, DR, Carvalheiro, A, Muiesan, P, Dutkowski, P, Puhan, M & Clavien, PA 2018, 'Defining Benchmarks in Liver Transplantation: A Multicenter Outcome Analysis Determining Best Achievable Results', Annals of Surgery, vol. 267, no. 3, pp. 419-425. https://doi.org/10.1097/SLA.0000000000002477
Muller, Xavier ; Marcon, Francesca ; Sapisochin, Gonzalo ; Marquez, Max ; Dondero, Federica ; Rayar, Michel ; Doyle, Majella M.B. ; Callans, Lauren ; Li, Jun ; Nowak, Greg ; Allard, Marc Antoine ; Jochmans, Ina ; Jacskon, Kyle ; Beltrame, Magali Chahdi ; Van Reeven, Marjolein ; Iesari, Samuele ; Cucchetti, Alessandro ; Sharma, Hemant ; Staiger, Roxane D. ; Raptis, Dimitri A. ; Petrowsky, Henrik ; De Oliveira, Michelle ; Hernandez-Alejandro, Roberto ; Pinna, Antonio D. ; Lerut, Jan ; Polak, Wojciech G. ; De Santibañes, Eduardo ; De Santibañes, Martín ; Cameron, Andrew M ; Pirenne, Jacques ; Cherqui, Daniel ; Adam, René A. ; Ericzon, Bö Göran ; Nashan, Bjoern ; Olthoff, Kim ; Shaked, Avi ; Chapman, William C. ; Boudjema, Karim ; Soubrane, Olivier ; Paugam-Burtz, Catherine ; Greig, Paul D. ; Grant, David R. ; Carvalheiro, Amanda ; Muiesan, Paolo ; Dutkowski, Philipp ; Puhan, Milo ; Clavien, Pierre Alain. / Defining Benchmarks in Liver Transplantation : A Multicenter Outcome Analysis Determining Best Achievable Results. In: Annals of Surgery. 2018 ; Vol. 267, No. 3. pp. 419-425.
@article{73a920243b81488d863b7b139b8c6696,
title = "Defining Benchmarks in Liver Transplantation: A Multicenter Outcome Analysis Determining Best Achievable Results",
abstract = "Objective: To propose benchmark outcome values in liver transplantation, serving as reference for assessing individual patients or any other patient groups. Background: Best achievable results in liver transplantation, that is, benchmarks, are unknown. Consequently, outcome comparisons within or across centers over time remain speculative. Methods: Out of 7492 liver transplantation performed in 17 international centers from 3 continents, we identified 2024 low risk adult cases with a laboratory model for end-stage liver disease score ≤20 points, a balance of risk score ≤9, and receiving a primary graft by donation after brain death. We chose clinically relevant endpoints covering intra- and postoperative course, with a focus on complications graded by severity including the complication comprehensive index (CCI {\circledR}). Respective benchmarks were derived from the median value in each center, and the 75 percentile was considered the benchmark cutoff. Results: Benchmark cases represented 8{\%} to 49{\%} of cases per center. One-year patient-survival was 91.6{\%} with 3.5{\%} retransplantations. Eighty-two percent of patients developed at least 1 complication during 1-year follow-up. Biliary complications occurred in one-fifth of the patients up to 6 months after surgery. Benchmark cutoffs were ≤4 days for ICU stay, ≤18 days for hospital stay, ≤59{\%} for patients with severe complications (≥ Grade III) and ≤42.1 for 1-year CCI {\circledR}. Comparisons with the next higher risk group (model for end stage liver disease 21-30) disclosed an increase in morbidity but within benchmark cutoffs for most, but not all indicators, while in patients receiving a second graft from 1 center (n = 50) outcome values were all outside of benchmark values. Conclusions: Despite excellent 1-year survival, morbidity in benchmark cases remains high with half of patients developing severe complications during 1-year follow-up. Benchmark cutoffs targeting morbidity parameters offer a valid tool to assess higher risk groups.",
keywords = "benchmark, complication, liver transplantation, morbidity, outcome",
author = "Xavier Muller and Francesca Marcon and Gonzalo Sapisochin and Max Marquez and Federica Dondero and Michel Rayar and Doyle, {Majella M.B.} and Lauren Callans and Jun Li and Greg Nowak and Allard, {Marc Antoine} and Ina Jochmans and Kyle Jacskon and Beltrame, {Magali Chahdi} and {Van Reeven}, Marjolein and Samuele Iesari and Alessandro Cucchetti and Hemant Sharma and Staiger, {Roxane D.} and Raptis, {Dimitri A.} and Henrik Petrowsky and {De Oliveira}, Michelle and Roberto Hernandez-Alejandro and Pinna, {Antonio D.} and Jan Lerut and Polak, {Wojciech G.} and {De Santiba{\~n}es}, Eduardo and {De Santiba{\~n}es}, Mart{\'i}n and Cameron, {Andrew M} and Jacques Pirenne and Daniel Cherqui and Adam, {Ren{\'e} A.} and Ericzon, {B{\"o} G{\"o}ran} and Bjoern Nashan and Kim Olthoff and Avi Shaked and Chapman, {William C.} and Karim Boudjema and Olivier Soubrane and Catherine Paugam-Burtz and Greig, {Paul D.} and Grant, {David R.} and Amanda Carvalheiro and Paolo Muiesan and Philipp Dutkowski and Milo Puhan and Clavien, {Pierre Alain}",
year = "2018",
month = "3",
day = "1",
doi = "10.1097/SLA.0000000000002477",
language = "English (US)",
volume = "267",
pages = "419--425",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Defining Benchmarks in Liver Transplantation

T2 - A Multicenter Outcome Analysis Determining Best Achievable Results

AU - Muller, Xavier

AU - Marcon, Francesca

AU - Sapisochin, Gonzalo

AU - Marquez, Max

AU - Dondero, Federica

AU - Rayar, Michel

AU - Doyle, Majella M.B.

AU - Callans, Lauren

AU - Li, Jun

AU - Nowak, Greg

AU - Allard, Marc Antoine

AU - Jochmans, Ina

AU - Jacskon, Kyle

AU - Beltrame, Magali Chahdi

AU - Van Reeven, Marjolein

AU - Iesari, Samuele

AU - Cucchetti, Alessandro

AU - Sharma, Hemant

AU - Staiger, Roxane D.

AU - Raptis, Dimitri A.

AU - Petrowsky, Henrik

AU - De Oliveira, Michelle

AU - Hernandez-Alejandro, Roberto

AU - Pinna, Antonio D.

AU - Lerut, Jan

AU - Polak, Wojciech G.

AU - De Santibañes, Eduardo

AU - De Santibañes, Martín

AU - Cameron, Andrew M

AU - Pirenne, Jacques

AU - Cherqui, Daniel

AU - Adam, René A.

AU - Ericzon, Bö Göran

AU - Nashan, Bjoern

AU - Olthoff, Kim

AU - Shaked, Avi

AU - Chapman, William C.

AU - Boudjema, Karim

AU - Soubrane, Olivier

AU - Paugam-Burtz, Catherine

AU - Greig, Paul D.

AU - Grant, David R.

AU - Carvalheiro, Amanda

AU - Muiesan, Paolo

AU - Dutkowski, Philipp

AU - Puhan, Milo

AU - Clavien, Pierre Alain

PY - 2018/3/1

Y1 - 2018/3/1

N2 - Objective: To propose benchmark outcome values in liver transplantation, serving as reference for assessing individual patients or any other patient groups. Background: Best achievable results in liver transplantation, that is, benchmarks, are unknown. Consequently, outcome comparisons within or across centers over time remain speculative. Methods: Out of 7492 liver transplantation performed in 17 international centers from 3 continents, we identified 2024 low risk adult cases with a laboratory model for end-stage liver disease score ≤20 points, a balance of risk score ≤9, and receiving a primary graft by donation after brain death. We chose clinically relevant endpoints covering intra- and postoperative course, with a focus on complications graded by severity including the complication comprehensive index (CCI ®). Respective benchmarks were derived from the median value in each center, and the 75 percentile was considered the benchmark cutoff. Results: Benchmark cases represented 8% to 49% of cases per center. One-year patient-survival was 91.6% with 3.5% retransplantations. Eighty-two percent of patients developed at least 1 complication during 1-year follow-up. Biliary complications occurred in one-fifth of the patients up to 6 months after surgery. Benchmark cutoffs were ≤4 days for ICU stay, ≤18 days for hospital stay, ≤59% for patients with severe complications (≥ Grade III) and ≤42.1 for 1-year CCI ®. Comparisons with the next higher risk group (model for end stage liver disease 21-30) disclosed an increase in morbidity but within benchmark cutoffs for most, but not all indicators, while in patients receiving a second graft from 1 center (n = 50) outcome values were all outside of benchmark values. Conclusions: Despite excellent 1-year survival, morbidity in benchmark cases remains high with half of patients developing severe complications during 1-year follow-up. Benchmark cutoffs targeting morbidity parameters offer a valid tool to assess higher risk groups.

AB - Objective: To propose benchmark outcome values in liver transplantation, serving as reference for assessing individual patients or any other patient groups. Background: Best achievable results in liver transplantation, that is, benchmarks, are unknown. Consequently, outcome comparisons within or across centers over time remain speculative. Methods: Out of 7492 liver transplantation performed in 17 international centers from 3 continents, we identified 2024 low risk adult cases with a laboratory model for end-stage liver disease score ≤20 points, a balance of risk score ≤9, and receiving a primary graft by donation after brain death. We chose clinically relevant endpoints covering intra- and postoperative course, with a focus on complications graded by severity including the complication comprehensive index (CCI ®). Respective benchmarks were derived from the median value in each center, and the 75 percentile was considered the benchmark cutoff. Results: Benchmark cases represented 8% to 49% of cases per center. One-year patient-survival was 91.6% with 3.5% retransplantations. Eighty-two percent of patients developed at least 1 complication during 1-year follow-up. Biliary complications occurred in one-fifth of the patients up to 6 months after surgery. Benchmark cutoffs were ≤4 days for ICU stay, ≤18 days for hospital stay, ≤59% for patients with severe complications (≥ Grade III) and ≤42.1 for 1-year CCI ®. Comparisons with the next higher risk group (model for end stage liver disease 21-30) disclosed an increase in morbidity but within benchmark cutoffs for most, but not all indicators, while in patients receiving a second graft from 1 center (n = 50) outcome values were all outside of benchmark values. Conclusions: Despite excellent 1-year survival, morbidity in benchmark cases remains high with half of patients developing severe complications during 1-year follow-up. Benchmark cutoffs targeting morbidity parameters offer a valid tool to assess higher risk groups.

KW - benchmark

KW - complication

KW - liver transplantation

KW - morbidity

KW - outcome

UR - http://www.scopus.com/inward/record.url?scp=85042412332&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85042412332&partnerID=8YFLogxK

U2 - 10.1097/SLA.0000000000002477

DO - 10.1097/SLA.0000000000002477

M3 - Article

C2 - 28885508

AN - SCOPUS:85042412332

VL - 267

SP - 419

EP - 425

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 3

ER -