Related Experiment Video
Updated: Jun 1, 2026
Extended 78% Hepatectomy in a Mouse Surgical Model
Published on: May 24, 2024
Impact of center volume on outcomes of increased-risk liver transplants
Deepak K Ozhathil1, You Fu Li, Jillian K Smith
1Solid Organ Transplantation, Surgical Outcomes Analysis & Research (SOAR), Department of Surgery, University of Massachusetts Medical School, Worcester, MA 01655, USA.
Insights
High-volume transplant centers better utilize high-donor risk index (DRI) livers, improving both allograft and recipient survival outcomes. This suggests specialized centers enhance outcomes for marginal organ transplants.
Area of Science:
- Transplantation immunology
- Organ procurement and allocation
- Surgical outcomes research
Background:
- Growing demand for liver transplants due to organ shortages.
- Underutilization of marginal donor livers, indicated by high-donor risk index (DRI).
- Need to evaluate center volume impact on outcomes with high-DRI grafts.
Purpose of the Study:
- To assess the effect of transplant center volume on survival outcomes for liver transplants using high-DRI allografts.
- To analyze differences in donor characteristics and outcomes between high-volume centers (HVCs) and lower-volume centers (LVCs).
Main Methods:
- Retrospective analysis of 31,576 deceased donor liver transplants (2002-2008) from the Scientific Registry of Transplant Recipients.
- Focus on a high-DRI cohort (DRI > 1.90, n = 15,668).
- Centers categorized into tertiles by annual procedure volume: HVCs, medium-volume centers (MVCs), and LVCs.
- Multivariate risk-adjusted frailty models used to assess allograft and recipient survival.
Main Results:
- HVCs utilized donors with higher mean DRIs, older donors (≥60 years), donors after stroke, and donation after cardiac death organs compared to MVCs and LVCs.
- Increased transplant center volume was associated with a reduced risk of allograft failure (HR=0.93, P=0.002).
- Higher procedure volume correlated with a decreased risk of recipient death (HR=0.90, P=0.004).
Conclusions:
- High-volume transplant centers demonstrate superior risk-adjusted survival outcomes for liver transplants using high-DRI grafts.
- HVCs effectively utilize higher-risk donor livers, achieving better allograft and recipient survival.
- Findings support improved understanding and utilization of high-DRI livers to enhance postoperative outcomes and allocation strategies.
Abstract:
The use of high-risk donor livers, which is reflective of the gross national shortage of organs available for transplantation, has gained momentum. Despite the demand, many marginal livers are discarded annually. We evaluated the impact of center volume on survival outcomes associated with liver transplantation using high-donor risk index (DRI) allografts. We queried the Scientific Registry of Transplant Recipients database for deceased donor liver transplants (n = 31,576) performed between 2002 and 2008 for patients who were 18 years old or older, and we excluded partial and multiple liver transplants. A high-DRI cohort (n = 15,668), which was composed of patients receiving grafts with DRIs > 1.90, was analyzed separately. Transplant centers (n = 102) were categorized into tertiles by their annual procedure volumes: high-volume centers (HVCs; 78-215 cases per year), medium-volume centers (MVCs; 49-77 cases per year), and low-volume centers (LVCs; 5-48 cases per year). The endpoints were allograft survival and recipient survival. In comparison with their lower volume counterparts, HVCs used donors with higher mean DRIs (2.07 for HVCs, 2.01 for MVCs, and 1.91 for LVCs), more donors who were 60 years old or older (18.02% for HVCs, 16.85% for MVCs, and 12.39% for LVCs), more donors who died after a stroke (46.52% for HVCs, 43.71% for MVCs, and 43.36% for LVCs), and more donation after cardiac death organs (5.04% for HVCs, 4.45% for MVCs, and 3.51% for LVCs, all P values < 0.001). Multivariate risk-adjusted frailty models showed that increased procedure volume at a transplant center led to decreased risks of allograft failure [hazard ratio (HR) = 0.93, 95% confidence interval (CI) = 0.89-0.98, P = 0.002] and recipient death (HR = 0.90, 95% CI = 0.83-0.97, P = 0.004) for high-DRI liver transplants. In conclusion, HVCs more frequently used higher DRI livers and achieved better risk-adjusted allograft and recipient survival. A greater understanding of the outcomes of transplantation with high-DRI livers may improve their utilization, the postoperative outcomes, and future allocation practices.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow