Effect of Institutional Case Volume on In-Hospital Mortality After Deceased Donor Liver Transplantation: A Nationwide Retrospective Cohort Study in Korea

There is still controversy as to whether the case volume affects clinical outcomes after liver transplantation. This nationwide retrospective cohort study aimed to investigate the relationship between institutional case volume and post-transplant outcomes after deceased donor liver transplantation.The data was extracted from the database of Korean National Healthcare Insurance Service. A total of 2648 adult deceased donor liver transplantations were performed at 54 centers in Korea from January 2007 to December 2016. Centers were divided into high-, medium-, and low-volume centers according to the average annual number of deceased donor liver transplantations as follows: 10, 10-30, and30.In-hospital mortality rates in high-, medium-, and low-volume centers were 10.3%, 14.3%, and 17.1%, respectively. Multivariable logistic regression analysis revealed that low-volume centers (adjusted odds ratio 1.953; 95% confidence interval, 1.461-2.611; P .001) and medium-volume centers (adjusted odds ratio 1.480; 95% confidence interval, 1.098-1.994; P = .010) had a significantly higher in-hospital mortality compared to high-volume centers. Long-term mortality rates were also higher in low-volume centers (P = .007).Centers with higher volume showed better in-hospital mortality and long-term survival after deceased donor liver transplantation compared to centers with lower volume.