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. 2011 May;11(5):958-64.
doi: 10.1111/j.1600-6143.2011.03487.x. Epub 2011 Apr 5.

Variation in organ quality between liver transplant centers

M L Volk  1 , H A Reichert, A S F Lok, R A Hayward
Affiliations

Variation in organ quality between liver transplant centers

M L Volk et al. Am J Transplant. 2011 May.

Abstract

A wide spectrum of quality exists among deceased donor organs available for liver transplantation. It is unknown whether some transplant centers systematically use more low quality organs, and what factors might influence these decisions. We used hierarchical regression to measure variation in donor risk index (DRI) in the United States by region, organ procurement organization (OPO) and transplant center. The sample included all adults who underwent deceased donor liver transplantation between January 12, 2005 and February 1, 2009 (n = 23,810). Despite adjusting for the geographic region and OPO, transplant centers' mean DRI ranged from 1.27 to 1.74, and could not be explained by differences in patient populations such as disease severity. Larger volume centers and those having competing centers within their OPO were more likely to use higher risk organs, particularly among recipients with lower model for end-stage liver disease (MELD) scores. Centers using higher risk organs had equivalent waiting list mortality rates, but tended to have higher post-transplant mortality (hazard ratio 1.10 per 0.1 increase in mean DRI). In conclusion, the quality of deceased donor organ patients receive is variable and depends in part on the characteristics of the transplant center they visit.

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Conflict of interest statement

Disclosure

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1
Figure 1
Distribution of Donor Risk Index (DRI) among livers transplanted into adult recipients, 2005–2009.
Figure 2
Figure 2
Mean DRI by transplant Region of the United States. The highest risk livers were used in Region 9 (New York and western Vermont), while the lowest risk livers were used in Region 11 (Kentucky, North Carolina, South Carolina, Tennessee, and Virginia).
Figure 3
Figure 3
Mean DRI by transplant center, adjusted for patient-level covariates and random effects of transplant region and OPO. The error bars represent 95% confidence intervals surrounding each center’s mean DRI, such that lack of overlap indicates statistical difference between centers.
Figure 4
Figure 4
Mean DRI by Model for End-stage Liver Disease (MELD) subgroup. The greatest discrepancy between low DRI centers and high DRI centers can be seen among the patients with low MELD scores, suggesting that centers that are more aggressive about using high risk organs do so primarily among the low MELD patients. P<0.001 by LR test in hierarchical modeling, adjusted for patient and center covariates (see Methods).
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Comment in

References

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