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Gu W, Schaaf L, Hortlik H, Zeleke Y, Brol MJ, Schnitzbauer AA, Bechstein WO, Zeuzem S, Queck A, Peiffer KH, Tischendorf M, Pascher A, Laleman W, Praktiknjo M, Schulz MS, Uschner FE, Rennebaum F, Trebicka J. Epidemiology of liver transplantation and post-LT complications in Germany: nationwide study (2005-2018). Eur J Gastroenterol Hepatol 2023; 35:1289-1297. [PMID: 37724476 PMCID: PMC10538604 DOI: 10.1097/meg.0000000000002640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/06/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND To date, liver transplantation (LT) is the only curative treatment for cirrhosis and early-diagnosed progressive acute liver failure (ALF). However, LT results in morbidities and mortality even post-LT. Different comorbidities may follow and further increase mortality and morbidity. In this study, we investigated the outcomes and their trends over a period of 14 years among hospitalized patients evaluated for LT, transplant and post-LT in Germany. METHODS This German nationwide study investigated the number of admissions of patients hospitalized for evaluation of LT and post-LT on related comorbidities and complications between 2005 and 2018 based on the DRG system with ICD-10/OPS codes. 14 745 patients were put on the LT waiting list and 12 836 underwent LT during the observational period. RESULTS The LT number decreased by 2.3% over time, while the waiting list mortality rate increased by 5%. By contrast, the in-hospital mortality rate decreased by 3%, especially in ALF patients (decrease of 16%). Interestingly, admissions of post-LT patients for complications almost doubled, driven mainly by complications of immunosuppression (tripled). Importantly, post-LT patients with acute kidney injury (20.2%) and biliodigestive anastomosis (18.4%) showed the highest in-hospital mortality rate of all complications. CONCLUSION In conclusion, the decrease in LT leads most probably to the increased in-hospital mortality of patients on the waiting list. Interestingly, in-hospital mortality decreased in LT patients. Post-LT comorbidities requiring hospitalization increased in the observational period and management of patients post-LT with AKI or biliodigestive anastomosis should be addressed.
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Affiliation(s)
- Wenyi Gu
- Department of Internal Medicine B, University Hospital Muenster, Muenster
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt
| | - Louisa Schaaf
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt
| | - Hannah Hortlik
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt
| | - Yasmin Zeleke
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt
| | - Maximilian J. Brol
- Department of Internal Medicine B, University Hospital Muenster, Muenster
| | - Andreas A. Schnitzbauer
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main
| | - Wolf O. Bechstein
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main
| | - Stefan Zeuzem
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt
| | - Alexander Queck
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt
| | - Kai-Henrik Peiffer
- Department of Internal Medicine B, University Hospital Muenster, Muenster
- Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt
| | | | - Andreas Pascher
- Department of General, Visceral, Transplant and Thoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Wim Laleman
- Department of Internal Medicine B, University Hospital Muenster, Muenster
- Department of Gastroenterology & Hepatology, Section of Liver and Biliopancreatic Disorders, University Hospitals of Leuven, KU Leuven, Leuven, Belgium
| | - Michael Praktiknjo
- Department of Internal Medicine B, University Hospital Muenster, Muenster
| | - Martin S. Schulz
- Department of Internal Medicine B, University Hospital Muenster, Muenster
| | - Frank E. Uschner
- Department of Internal Medicine B, University Hospital Muenster, Muenster
| | - Florian Rennebaum
- Department of Internal Medicine B, University Hospital Muenster, Muenster
| | - Jonel Trebicka
- Department of Internal Medicine B, University Hospital Muenster, Muenster
- European Foundation for Study of Chronic Liver Failure, Barcelona, Spain
- Department of Gastroenterology and Hepatology, Odense University Hospital, Odense, Denmark
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Williment C, Beaulieu L, Clarkson A, Gunderson S, Hartell D, Escoto M, Ippersiel R, Powell L, Kirste G, Nathan HM, Opdam H, Weiss MJ. Organ Donation Organization Architecture: Recommendations From an International Consensus Forum. Transplant Direct 2023; 9:e1440. [PMID: 37138552 PMCID: PMC10150918 DOI: 10.1097/txd.0000000000001440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 05/05/2023] Open
Abstract
This report contains recommendations from 1 of 7 domains of the International Donation and Transplantation Legislative and Policy Forum (the Forum). The purpose is to provide expert guidance on the structure and function of Organ and Tissue Donation and Transplantation (OTDT) systems. The intended audience is OTDT stakeholders working to establish or improve existing systems. Methods The Forum was initiated by Transplant Québec and co-hosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. This domain group included administrative, clinical, and academic experts in OTDT systems and 3 patient, family, and donor partners. We identified topic areas and recommendations through consensus, using the nominal group technique. Selected topics were informed by narrative literature reviews and vetted by the Forum's scientific committee. We presented these recommendations publicly, with delegate feedback being incorporated into the final report. Results This report has 33 recommendations grouped into 10 topic areas. Topic areas include the need for public and professional education, processes to assure timely referral of patients who are potential donors, and processes to ensure that standards are properly enforced. Conclusions The recommendations encompass the multiple roles organ donation organizations play in the donation and transplantation process. We recognize the diversity of local conditions but believe that they could be adapted and applied by organ donation organizations across the world to accomplish their fundamental objectives of assuring that everyone who desires to become an organ donor is given that opportunity in a safe, equitable, and transparent manner.
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Affiliation(s)
- Claire Williment
- Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | | | - Anthony Clarkson
- Organ Donation and Transplantation, NHS Blood and Transplant, London, United Kingdom
| | | | - David Hartell
- Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, Canada
| | - Manuel Escoto
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Richard Ippersiel
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Linda Powell
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Gunter Kirste
- Albert Ludwigs University Freiburg, Medical Center, Freiburg, Germany
| | | | - Helen Opdam
- Australian Organ and Tissue Authority, Canberra, Australia
| | - Matthew J. Weiss
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Gift of Life Donor Program, Philadelphia, PA
- Transplant Québec, Montréal, QC, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, QC, Canada
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Rehsmann J. Failing livers, anticipated futures and un/desired transplants. Anthropol Med 2022; 29:92-106. [PMID: 35187998 DOI: 10.1080/13648470.2021.2017126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This article looks at liver transplants as life-prolonging treatment for chronic liver failure and examines the role anticipation plays in the context of chronic liver conditions. Based on anthropological fieldwork in Germany, this article draws on three exemplary patient accounts to show how the anticipatory experience of waiting for a liver transplant serves as an important period in transplant trajectories, and how the lack of a wait may have long-term consequences for patients' wellbeing. A focus on waiting and anticipation in the context of chronic livers enables new understandings of the complex temporal qualities that living with chronic conditions entails. As the sole long-term treatment available for failing livers, the possibilities of transplant medicine shape patients' anticipation of their future. Conversely, the particular futures that patients anticipate mould how they make sense of their transplant and their chronic pre- and post-transplant lives. This article shows that rather than offering a unilinear treatment with a clear-cut end, liver transplants, as treatment for a wide range of chronic conditions, reproduce chronic lives.
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Affiliation(s)
- Julia Rehsmann
- Department of Health Professions, Bern University of Applied Science, Bern, Switzerland.,Institute of Social Anthropology, University of Bern, Bern, Switzerland
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Loosen SH, Bock HH, Hellmich M, Knoefel WT, Trautwein C, Keitel V, Bode JG, Neumann UP, Luedde T. Hospital Mortality and Current Trends in Liver Transplantation in Germany—a Systematic Analysis of Standardized Hospital Discharge Data, 2008–2017. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:497-502. [PMID: 33888199 DOI: 10.3238/arztebl.m2021.0210] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 07/28/2020] [Accepted: 04/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Liver transplantation (LT) has undergone dynamic developments in recent decades. In Germany, the Federal Joint Committee (G-BA) recently tightened the guidelines regarding the minimum number of transplantations a center should perform annually. The aim of the study presented here, was to analyze recent trends in hospital mortality due to LT in Germany. METHODS Standardized hospital discharge data (2008-2017) from the Federal Statistical Office of Germany were used to establish hospital mortality after LT and case volume distribution among centers performing <20 LT annually (low volume centers, LVC), 20-49 LT (medium volume centers, MVC), and ≥ 50 LT (high volume centers, HVC). RESULTS Data from 9254 LT procedures were evaluated. The annual frequency of LT fell from n = 984 (2008) to n = 747 (2017), and over the same period the hospital mortality for all LT procedures went down from 15.8% to 11.0%. Hospital mortality was associated with age (<16 years: 5.3% to 60-69 years: 17.4%); however, there was no further increase in patients ≥ 70 years (16.5%). Univariate analysis revealed association of increased hospital mortality with liver disease etiology, the necessity for relaparotomy, and prolonged mechanical ventilation. The proportion of LT procedures performed in LVC and MVC increased and that in HVC decreased. LVC had higher hospital mortality than MVC/HVC, but this effect was dependent on patient age and disease etiology. CONCLUSION Our study showed that differences in mortality rate after LT among centers (LVC vs. MVC/HVC) were dependent on patient age and disease etiology. This should be taken into account when discussing the overall organization of LT in Germany.
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Pfaller L, Hansen SL, Adloff F, Schicktanz S. 'Saying no to organ donation': an empirical typology of reluctance and rejection. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:1327-1346. [PMID: 29956337 DOI: 10.1111/1467-9566.12775] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
In Germany, as well as in other countries, organ shortages are usually explained by a relative unwillingness to donate among a population which is assumed to be caused by a lack of information and mistrust of the system. As we can see in the data of our qualitative research (focus groups and interviews), lack of information or mistrust are not the only reasons for people to be reluctant to agree to the donation of their organs after death. In fact we can identify four positions: (1) information deficit; (2) mistrust; (3) no killing; and (4) bodily integrity. The first and second are the two prominent explanations in the public discourse about low donation rates. The third and the fourth instead have neither been adequately articulated nor been discussed as a proper argument. Therefore, by means of sociology of critique, we discuss their contribution to the discourse as comprehensible reasons for reluctance and present them as credible positions of criticism: These two positions illuminate fundamental and universal values of the inviolability of the person and human dignity. Thus, both positions are consistent and morally justifiable and should be addressed with sensitivity.
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Affiliation(s)
- Larissa Pfaller
- Institute for Sociology, Friedrich-Alexander-University, Erlangen-Nürnberg, Germany
| | - Solveig L Hansen
- Department of Medical Ethics and the History of Medicine, University Medical Center, Göttingen, Germany
| | - Frank Adloff
- Department of Social Economics, University of Hamburg, Hamburg, Germany
| | - Silke Schicktanz
- Department of Medical Ethics and the History of Medicine, University Medical Center, Göttingen, Germany
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Schicktanz S, Pfaller L, Hansen SL, Boos M. Attitudes towards brain death and conceptions of the body in relation to willingness or reluctance to donate: results of a student survey before and after the German transplantation scandals and legal changes. J Public Health (Oxf) 2017. [DOI: 10.1007/s10389-017-0786-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Schwettmann L. Decision solution, data manipulation and trust: The (un-)willingness to donate organs in Germany in critical times. Health Policy 2015; 119:980-9. [PMID: 25684705 DOI: 10.1016/j.healthpol.2015.01.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 01/19/2015] [Accepted: 01/28/2015] [Indexed: 12/21/2022]
Abstract
In 2011 and 2012 a change of rules and a data-manipulation scandal focused German public attention on organ donation. This increased citizens' background knowledge as well as their willingness to respond to surveys. The present study is an effort to seize this research opportunity and to create evidence on which policy recommendations can be conceivably based. It uses data from two major representative surveys from 2011 to 2012 to address four central questions: Which characteristics, experiences and attitudes correlate with the written or unwritten willingness of individuals to donate (WTD) their own organs post-mortem? How has the WTD changed over time? To what extent does the WTD depend on normative trust? Which factors correlate with trust? The data is analyzed through summary statistics and regression models. Several hypotheses regarding factors connected with the WTD are confirmed in the survey results. Altruistic motives, relevant knowledge and trust are decisive. The special role of trust is corroborated by the data. As current German politics prevents the introduction of post-mortem donation incentives, potential policy making proposals are restricted to institutional changes to regain trust including the implementation of an organ donor registry and the advancement of counselling talks with general practitioners.
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Affiliation(s)
- Lars Schwettmann
- Martin-Luther-University Halle-Wittenberg, Department of Economics, Universitätsring 3, D-06108 Halle (Saale), Germany.
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