Clinical

Organ quality varies among liver transplant centers

Last Updated: 2010-05-05 14:14:12 -0400 (Reuters Health)

By Jim Kling

SAN DIEGO (Reuters Health) - The quality of livers used for transplant varies significantly among transplant programs in the U.S. - and programs that use lower quality organs have worse post-transplant survival rates, researchers said this week at the American Transplant Congress 2010.

The variation in liver graft quality from center to center may be due to a difference in willingness to use high risk organs, said Dr. Michael Volk from the University of Michigan Health System in Ann Arbor in his presentation.

Using data from the Scientific Registry of Transplant Recipients (SRTR) on deceased donor transplants done in adults from 2005 to 2009, Dr. Volk and his colleagues calculated a Donor Risk Index (DRI).

They ranked transplant centers according to median DRI, and adjusted for factors that could be related to transplant region or organ procurement organization (OPO). They also adjusted for patient-level and center-level variables - including transplant volume and mean model for end-stage liver disease (MELD) scores at transplant.

In centers that conducted at least ten liver transplants, the median DRI varied from 1.16 to 1.76. After adjustment for patient-level risk factors, DRI varied more at the center-level (intra-class correlation coefficient, ICC=2.5%) than by OPO (ICC=1.5%) or region (ICC=2.4%).

Lower MELD score, older age, female gender, encephalopathy, non-hepatitis C, no prior transplant, and non-MELD exception predicted higher DRI.

High DRI transplants were also more common in large-volume centers.

Centers with higher median DRI transplants showed higher post-transplant mortality rates (hazard ratio 2.6, p=0.005). "(The results) translate into centers at the 80th percentile of DRI ranking having a greater than 30% higher hazard ratio in post-transplant mortality than centers in the 20th percentile," Dr. Volk noted.

His study points to a lack of standardization among centers in willingness to use high risk organs, Dr. Volk said. The results can't be used to judge clinical practices, but it does have policy implications, he said.

Dr. Volk also said there needs to be adequate informed consent for recipients about the quality of organs they're likely to receive. "This is a difficult conversation to have. It's a complex subject and a high risk subject," Dr. Volk said, adding that his team is developing patient education tools to assist these efforts.

Dr. Volk also suggested there should be more public reporting of the quality of organs at centers, "or at the very least private feedback to centers so they can compare their practices to national standards."