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Published on: June 17, 2020
Variation in organ quality between liver transplant centers
M L Volk1, H A Reichert, A S F Lok
1Division of Gastroenterology and Hepatology, University of Michigan, MI, USA. mvolk@med.umich.edu
Summary
Transplant centers vary in their use of lower-quality deceased donor livers. Factors like center volume and competition influence organ selection, impacting post-transplant survival rates.
Area of Science:
- Transplantation Medicine
- Organ Procurement
- Health Services Research
Background:
- Deceased donor liver organ quality varies significantly.
- It remains unclear if transplant centers systematically utilize lower-quality organs.
- Factors influencing these organ selection decisions are not well understood.
Purpose of the Study:
- To investigate variations in deceased donor liver organ quality used by transplant centers.
- To identify factors associated with the use of higher-risk organs.
- To assess the impact of organ quality on patient outcomes.
Main Methods:
- Hierarchical regression analysis was employed.
- Data included adult deceased donor liver transplants in the US (2005-2009).
- Donor Risk Index (DRI) variation was measured across regions, OPOs, and transplant centers.
Main Results:
- Significant variation in mean DRI (1.27-1.74) existed between transplant centers, independent of geography or OPO.
- Higher volume centers and those with competing centers within their OPO were more likely to use higher-risk organs, especially for lower MELD score recipients.
- Centers using higher-risk organs showed similar waiting list mortality but higher post-transplant mortality.
Conclusions:
- Deceased donor liver organ quality received by patients is variable.
- Transplant center characteristics, including volume and competition, influence organ selection.
- The use of higher-risk organs is associated with increased post-transplant mortality.
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