Identification of high functioning hepatocellular carcinoma transplant centers in the modern allocation system

Hepatocellular carcinoma (HCC) is a common indication for liver transplant. We set out to identify high performing HCC centers to understand their listing and donor acceptance patterns.

The Organ Procurement and Transplantation Network data was quired identifying patients with HCC. Centers were stratified into high functioning (HFC) and low functioning centers (LFC) based on the percentage of waitlisted patients who were transplanted and patients who died or were delisted (DDL).

Multivariable analysis identified utilization of donor after circulatory death (DCD) (OR 2.25 p < 0.01) as the largest contributing factor in HFC. The current LFC transplant to DDL ratio is 1.3 whereas HFC have experiences a 1.8-fold increase from the implementation of acuity circle (AC) allocation with a transplant to DDL ratio of 9.5. Multivariable analysis suggests that this gain is related to adopting the use of DCD donor after the implantation of AC allocation (OR 4.22, p < 0.01).

High functioning HCC transplant center phenotype exists and appears to be most driven by the utilization of DCD donors. AC allocation has served to exacerbate disparities between HFC and LFC with the key adaptation made being the increased use of DCD donors.