High-Volume Liver Transplant Centers Up Recipient Survival
Allograft, recipient survival better despite use of donors with high donor risk index livers
MONDAY, Oct. 17 (HealthDay News) -- Liver transplant centers with high annual procedure volumes use donors with higher mean donor risk index (DRI) livers and have better risk-adjusted recipient and allograft survival than centers with low annual procedure volumes, according to a study published in the October issue of Liver Transplantation.
Deepak K. Ozhathil, M.D., from the University of Massachusetts Medical School in Worcester, and colleagues investigated the impact of annual procedure volume survival outcomes associated with use of high-DRI liver allografts. The transplant centers were divided into tertiles according to their annual procedure volumes: high-volume centers (HVCs), medium-volume centers, and low-volume centers (LVCs). A total of 31,576 deceased-donor liver transplants (aged 18 years and older), performed between 2002 and 2008, were analyzed. A separate analysis was carried out for 15,668 patients receiving grafts with DRIs greater than 1.90. Allograft survival and recipient survival were the major end points.
The investigators found that, compared to LVCs, the HVCs used donors with higher mean DRI (2.07 versus 1.19), more donation after cardiac death organs (5.04 versus 3.51 percent), more donors who were 60 years or older (18.02 versus 12.39 percent), and more donors who died after a stroke (46.52 versus 43.36 percent). In multivariate risk-adjusted frailty models, increased transplant center procedure volume correlated with significantly decreased risks of allograft failure and recipient death for high-DRI liver transplants (hazard ratio, 0.93 and 0.90, respectively).
"HVCs more frequently used higher DRI livers and achieved better risk-adjusted allograft and recipient survival," the authors write.