Impact of center volume on increased risk liver transplant outcomes

Abstract

Reflective of the gross national shortage of organs available for transplantation, utilization of high-risk donor livers has gained momentum. Despite these demands, many marginal livers are discarded annually. Our study evaluated the impact of center volume on survival outcomes associated with liver transplants utilizing high donor risk index (DRI) allografts. METHODS: We queried the SRTR database for deceased donor liver transplants (n=31,587) among recipients ≥18 years old from 2002-2008, and excluded partial and multiple-liver transplants. A high-DRI cohort (n=15,668), defined as DRI >1.90, was analyzed separately. Transplant centers (n=102) were categorized into tertiles by annual procedure volumes: High (HVC: 78-215 cases/year), Medium (MVC: 49-77 cases/year) and Low (LVC: 5-48 cases/year). Endpoints were allograft and recipient survival. RESULTS: Compared to their lower volume counterparts, HVC utilized donors with higher mean DRI (HVC: 2.07, MVC: 2.01, LVC: 1.91), ≥60 years of age (HVC: 18.02%, MVC: 16.85%, LVC: 12.39%), deceased following stroke (HVC: 46.53%, MVC: 43.71%, LVC: 43.36%) and donation after cardiac death (HVC: 5.04%, MVC: 4.53%, LVC: 3.50%; all p CONCLUSION: High volume centers more frequently utilized higher DRI livers and achieved better risk-adjusted allograft and recipient survival. Further understanding of outcomes following use of high DRI livers may improve utilization, post-operative outcomes and potentially future allocation practices. Liver Transpl, 2011. © 2011 AASLD. Copyright © 2011 American Association for the Study of Liver Diseases.