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.

Additional Metadata
Keywords benchmark, complication, liver transplantation, morbidity, outcome
Persistent URL dx.doi.org/10.1097/SLA.0000000000002477, hdl.handle.net/1765/104905
Journal Annals of Surgery
Note No subscription
Citation
Muller, X. (Xavier), Marcon, F. (Francesca), Sapisochin, G. (Gonzalo), Marquez, M. (Max), Dondero, F. (Federica), Rayar, M. (Michel), … Clavien, P.A. (2018). Defining Benchmarks in Liver Transplantation. Annals of Surgery, 267(3), 419–425. doi:10.1097/SLA.0000000000002477