Surgical mortality in the US is widely perceived to be superior to that in the United Kingdom (UK).
Previous comparisons of surgical outcome in the 2 countries have often failed to take sufficient account of case-mix or examine long-term outcome.
The standardized nature of liver transplantation practice makes it uniquely placed for undertaking reliable international comparisons of surgical outcome.
Dr Dawwas and colleagues from England undertook a risk-adjusted disease-specific comparison of both short- and long-term survival of liver transplant recipients in the UK and Ireland with that in the USA.
|Mortality is higher among USA liver transplant recipients after the first year|
The team conducted a multicenter cohort study using 2 high quality national databases between 1994 and 2005.
The investigative team assessed 5925 adults who underwent a first single organ liver transplant in the UK and Ireland, and 41,866 in the USA.
The team's main outcome measures were post-transplant mortality during the first 90 days, 90 days to 1 year, and beyond the first year.
The team adjusted for recipient and donor characteristics.
Risk-adjusted mortality in the UK and Ireland was generally higher than in the USA during the first 90 days.
The team observed this increase in both patients transplanted for acute liver failure, and those transplanted for chronic liver disease.
The team found no statistically significant differences in overall risk-adjusted mortality between the 2 cohorts between 90 days and 1 year post-transplantation.
Survivors of the first post-transplant year in the UK and Ireland had lower overall risk-adjusted mortality than those transplanted in the USA.
The investigators noted this difference among patients transplanted for chronic liver disease, but not those transplanted for acute liver failure.
Dr Dawwas' team concluded, "Whilst risk-adjusted mortality is higher in the UK and Ireland during the first 90 days following liver transplantation, it is higher in the US among those liver transplant recipients who survived the first post-transplant year."
"Our results are consistent with the notion that the USA has superior acute perioperative care whereas the UK appears to provide better quality chronic care following liver transplantation surgery."