Finding Value in Pediatric Liver Transplantation: When Does Volume Matter?

Area of Science:

• Pediatric Surgery
• Transplantation Medicine
• Health Services Research

Background:

• Pediatric liver transplantation significantly improves survival rates.
• Value-based healthcare models are increasingly important but understudied in pediatric transplantation.
• Defining value in pediatric liver transplantation is crucial for optimizing outcomes and managing costs.

Purpose of the Study:

• To investigate the relationship between pediatric liver transplant center volume and value of care.
• To assess how center volume impacts graft survival and resource utilization in pediatric liver transplant recipients.
• To determine if a volume-value relationship exists across different pediatric age groups.

Main Methods:

• Analysis of deceased donor pediatric liver transplant recipients (n=5770) from 2002-2019 using UNOS data.
• Centers categorized into volume tertiles (small, medium, large); recipients stratified by age (0-4, 5-11, 12-18 years).
• Value defined as % 1-year graft survival / mean post-transplant length of stay; Mahalanobis matching used to control for confounders.

Main Results:

• Large centers showed better 1-year graft survival (93.7%) than small centers (89.4%) without increased length of stay.
• A volume-value relationship (better outcomes, less resource use) was observed in the 0-4 age group.
• The 0-4 age group had the highest proportion of status 1B patients and partial allograft use.

Conclusions:

• Liver transplant center volume is associated with value in very young (0-4 years) pediatric recipients.
• Higher volume centers provide improved survival for this young population.
• Regionalization of care may be beneficial for improving outcomes in very young pediatric liver transplant recipients.