Clinical

Long-term liver transplant better in UK than in US

Last Updated: 2007-11-21 12:47:02 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Although patients undergoing liver transplantation in the US have better 90-day survival, many of those who undergo the procedure in the UK and Ireland seem to do better after the first year, UK researchers report in the November issue of Gut.

Dr. Muhammad F. Dawwas of Addenbrooke's Hospital, Cambridge and colleagues note that international comparisons of surgical results can be problematic and often fail to allow for long-term results.

However, they point out that the "standardised nature of liver transplantation practice makes it uniquely placed for undertaking reliable international comparisons of surgical outcome."

To investigate further, the researchers examined data for a 10-year period. This covered all 5925 transplants which took place in the UK and Ireland as well as all 41,866 transplants which had been conducted in the US during the same time interval.

In the UK group, at 90 days, risk-adjusted mortality was greater than in the US (hazard ratio, 1.17). This was true for patients with acute liver failure (hazard ratio, 1.27) and those who had had chronic liver disease (hazard ratio, 1.18).

There were no significant international group differences between 90 days and 1 year. However, after a year, those transplanted in the UK or Ireland because of chronic liver disease did better than US patients (hazard ratio, 0.88). An exception was for acute liver failure patients (hazard ratio, 1.02).

"These results highlight interesting differences between two health systems funded by entirely different mechanisms," Dr. Dawwas told Reuters Health. "A predominantly privately funded healthcare system, such as the one in the United States, was demonstrated to have better short-term outcome for liver transplantation, but a system of universal publicly funded healthcare, as in the UK, had a better outcome after the first post-transplant year."

"Our results therefore could have important implications for health policymakers in those countries and beyond," he concluded.

Gut 2007;56:1606-1613.