Hospital mortality and current developments of liver transplantation in Germany: A systematic 10-year analysis

Background Both internationally and in Germany, liver transplantation (LT) has undergone a dynamic development in recent decades. This has included a complete change in the allocation system with the introduction of the MELD-system, but also challenges such as those arising from the irregularities at four German liver transplant centers exposed in 2012. In addition, there is an ongoing discussion in Germany about the total number of centers at which LT is carried out and the Joint Federal Committee (G-BA) has recently reinforced the guidelines regarding minimum transplantation numbers. A systematic evaluation of existing data sets and their careful interpretation can support a rational discussion aiming at optimizing framework conditions of LT.

Methods We used standardized hospital discharge data (diagnosis-related groups and German operations and procedure key codes) to analyze hospital mortality after LT in Germany between 2008 and 2017. Data were provided by the Federal Statistical Office of Germany.

Result A total of n = 9254 LT procedures performed between 2008 and 2017 were included into the present analysis. Annual LT frequency decreased by 24.09 % from 2008 (n = 984) to 2017 (n = 747). The average hospital mortality rate of all LT procedures was 14.3 % and showed a significant improvement during the observation period (2008: 15.8 %, 2017: 11.0 %). Hospital mortality significantly correlated with recipient age ( < 40 years: 9.4 %, ≥40 years: 12.9 %, ≥50years: 15.5 %, ≥60 years: 17.4 %) but did not further increase in patients ≥70 years (16.5 %). We identified the underlying liver disease etiology, the need for relaparotomy as well as prolonged mechanical ventilation as further factors associated with an increased hospital mortality. In addition, hospital mortality significantly differed between German federal states ranging from 9.6 % to 24.1 %. Finally, transplantation centers that performed less than 20 LT annually had a significantly higher mortality rate than centers that performed ≥20 LT yearly.

Conclusion LT-related hospital mortality has fallen steadily over the last years, and LT is a safe therapy even in well-selected elderly recipients. Our study identified a number of variables associated with increased mortality. Against the background that our study considers parameters of the current G-BA guideline on minimum numbers of LT, these data provide a scientific basis for the current discussion on the reorganization of LT in Germany.

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Artikel online veröffentlicht:
04. Januar 2021