Liver transplant outcomes better in UK than U.S.

By David Douglas

NEW YORK (Reuters Health) - Although patients who undergo liver transplants in the U.S. have a better 90-day survival rate, 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 "standardized 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. The data covered all 5,925 transplants performed in the UK and Northern Ireland as well as all 41,866 transplants conducted in the U.S. during the same time interval.

In the UK group, at 90 days, the mortality was about 17 percent greater than in the U.S. Similar 90-day mortality increases were seen in the UK group for patients with acute liver failure - 27 percent - and for those with chronic liver disease - 18% percent.

There were no significant international group differences between 90 days and 1 year. However, after 1 year, those who received their transplant in the UK or Northern Ireland because of chronic liver disease did better than U.S. patients. An exception was for acute liver failure patients who had similar outcomes in both groups.

"These results highlight interesting differences between two health systems funded by entirely different mechanisms," Dawwas told Reuters Health. "A predominantly privately funded healthcare system, such as the one in the United States, was demonstrated to have a 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.