It has been demonstrated that low-volume orthotopic liver transplant centers have poorer outcomes compared to high-volume centers.
Dr Patrick Northup and colleagues from Virginia performed an analysis of transplant center procedure volume and mortality with data from the Model for End-stage Liver Disease (MELD) era.
The team analyzed 9909 adult liver transplants performed in the United States since the beginning of the Model for End-stage Liver Disease allocation system.
Transplant centers were categorized by volume of transplants performed per year.
Multivariate survival models were constructed with raw survival as the primary endpoint for both high- and low-volume centers.
The researchers categorized 30% of centers as low volume, with less than 20 liver transplants per year.
|8% of all transplants were performed at low-volume centers|
|American Journal of Transplantation|
The team noted that 8% of all transplants were performed at low-volume centers.
The unadjusted raw mortality rate at 1-year post-transplant at high-volume centers was significantly lower than the rate at low-volume centers.
However, after the team adjusted for disease severity and multiple donor and recipient factors, transplant center volume was no longer a significant predictor of post-transplant survival.
Dr Northup's team conclude, “Transplant center case volume is no longer a significant predictor of post-transplant survival in the Model for End-stage Liver Disease era.”
“Factors which are currently unaccounted for in present survival models should be investigated.”