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We thank our correspondents for their interest and the positive feedback on our study (1). DRG based hospital discharge data from the Federal Statistical Office constitute a valuable basis for the independent and objective analysis of hospital mortality in Germany. As we explained and extensively discussed in our article, multiple other factors are involved in hospital mortality, in addition to treatment quality. The wording we used for higher hospital mortality in centers with a lower transplantation volume (“low volume” center, <20 liver transplantations/year) reflects this appropriately, in our view. Statistically significant associations were reported accordingly.

In conclusion, we wish to note that—in addition to treatment quality—multiple parameters and influencing factors obviously affect hospital mortality after liver transplantation. We also agree with the comment that medical control of treatment quality is of crucial importance. These two issues are, however, relevant not only for liver transplantation but for all highly complex surgical and interventional procedures. In addition to the undoubtedly important individual quality controls of transplant centers, we are therefore of the opinion that the overriding analysis of hospital mortality and the factors influencing it—in spite of the existing limitations, for example, the lacking option to carry out a MELD corrected mortality analysis in our data analysis—is a justifiable and necessary component of quality assurance in liver transplantation in Germany.

DOI: 10.3238/arztebl.m2022.0040

On behalf of the authors

PD Dr. med. Sven H. Loosen, Prof. Dr. med. Tom Luedde

Klinik für Gastroenterologie, Hepatologie und Infektiologie,
Universitätsklinikum Düsseldorf,
Medizinische Fakultät der Heinrich-Heine-Universität Düsseldorf

sven.loosen@med.uni-duesseldorf.de, luedde@hhu.de

Conflict of interest statement

Dr. Loosen received reimbursement of travel costs and lecture fees from Roche, MSD und BMS.

Prof. Luedde received counsel fees from Roche, Eisai, BMS, MSD, Sanofi, Incyte, Merck, and Bayer. He was reimbursed for conference fees and travel expenses by EASL and received lecture fees from Falk.

1.
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. Dtsch Arztebl Int 2021; 118: 497–502 VOLLTEXT
1.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. Dtsch Arztebl Int 2021; 118: 497–502 VOLLTEXT

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