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Published on: August 15, 2022
The volume-outcomes relationship in donation after circulatory death liver transplantation
Aaron M Delman1, Kevin M Turner1, Allison M Ammann1
1Cincinnati Research in Outcomes and Safety in Surgery (CROSS) Research Group, Department of Surgery, University of Cincinnati College of Medicine, CARE/Crawley Building, Cincinnati, Ohio, USA.
Insights
Higher volume Donation after Circulatory Death (DCD) liver transplant (LT) centers achieve better patient and graft survival. Low-volume DCD LT centers are associated with increased mortality and graft failure.
Area of Science:
- Transplantation Medicine
- Hepatology
- Organ Donation
Background:
- Donation after Circulatory Death (DCD) liver transplantation (LT) expands the donor pool and reduces waitlist mortality.
- Outcomes at low-volume DCD LT centers compared to high-volume centers remain unclear.
Purpose of the Study:
- To compare donor and recipient selection and survival outcomes between very-low volume (VLV), low-volume (LV), and high-volume (HV) DCD LT centers.
- To determine if DCD LT center volume impacts patient and graft survival.
Main Methods:
- Utilized the United Network for Organ Sharing (UNOS) database from 2011 to 2019.
- Categorized 110 liver transplant centers into tertiles based on annual DCD LT volume: VLV (1-2/year), LV (3-5/year), and HV (>5/year).
- Compared donor/recipient selection and survival outcomes (30-day, 90-day, 1-year) across center volumes.
Main Results:
- High-volume centers performed 70.4% of the 3273 DCD LTs, showing significantly increased 1-year patient and graft survival (P < .05).
- Recipients at HV centers experienced shorter waitlist durations and hospital stays (P < .01).
- Undergoing DCD LT at VLV or LV centers was linked to increased 1-year patient mortality and graft failure (ORs > 1).
Conclusions:
- Increased annual DCD liver transplant volume is associated with improved patient and graft survival.
- DCD LT center volume is a critical factor influencing transplant outcomes.
Background:
Donation after circulatory death (DCD) liver transplantation (LT) has become an effective mechanism for expanding the donor pool and decreasing waitlist mortality. However, it is unclear if low-volume DCD centers can achieve comparable outcomes to high-volume centers.
Methods:
From 2011 to 2019 utilizing the United Network for Organ Sharing (UNOS) database, liver transplant centers were categorized into tertiles based on their annual volume of DCD LTs. Donor selection, recipient selection, and survival outcomes were compared between very-low volume (VLV, n = 1-2 DCD LTs per year), low-volume (LV, n = 3-5), and high-volume (HV, n > 5) centers.
Results:
One hundred and ten centers performed 3273 DCD LTs. VLV-centers performed 339 (10.4%), LV-centers performed 627 (19.2%), and HV-centers performed 2307 (70.4%) LTs. 30-day, 90-day, and 1-year patient and graft survival were significantly increased at HV-centers (all P < .05). Recipients at HV-centers had shorter waitlist durations (P < .01) and shorter hospital lengths of stay (P < .01). On multivariable regression, undergoing DCD LT at a VLV-center or LV-center was associated with increased 1-year patient mortality (VLV-OR:1.73, 1.12-2.69) (LV-OR: 1.42, 1.01-2.00) and 1-year graft failure (VLV-OR: 1.79, 1.24-2.58) (LV-OR: 1.28, .95-1.72).
Discussion:
Increased annual DCD liver transplant volume is associated with improved patient and graft survival.
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