Effect of centre volume and high donor risk index on liver allograft survival

Deepak K. Ozhathil, Youfu Li, Jillian K. Smith, Jennifer F. Tseng, Reza F. Saidi, Adel Bozorgzadeh, Shimul A. Shah

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Background: A growth in the utilization of high-risk allografts is reflective of a critical national shortage and the increasing waiting list mortality. Using risk-adjusted models, the aim of the present study was to determine whether a volume-outcome relationship existed among liver transplants at high risk for allograft failure. Methods: From 2002 to 2008, the Scientific Registry of Transplant Recipients (SRTR) database for all adult deceased donor liver transplants (n= 31 587) was queried. Transplant centres (n= 102) were categorized by volume into tertiles: low (LVC; 31 cases/year), medium (MVC: 64 cases/year) and high (HVC: 102 cases/year). Donor risk comparison groups were stratified by quartiles of the Donor Risk Index (DRI) spectrum: low risk (DRI 1.63), moderate risk (1.64 > DRI > 1.90), high risk (1.91 > DRI > 2.26) and very high risk (DRI 2.27). Results: HVC more frequently used higher-risk livers (median DRI: LVC: 1.82, MVC: 1.90, HVC: 1.97; P < 0.0001) and achieved better risk adjusted allograft survival outcomes compared with LVC (HR: 0.90, 95%CI: 0.85-0.95). For high and very high risk groups, transplantation at a HVC did contribute to improved graft survival [high risk: hazard ratio (HR): 0.85, 95% confidence interval (CI): 0.76-0.96; Very High Risk: HR: 0.88, 95%CI: 0.78-0.99]. Conclusion: While DRI remains an important aspect of allograft survival prediction models, liver transplantation at a HVC appears to result in improved allograft survival with high and very high risk DRI organs compared with LVC.

Original languageEnglish (US)
Pages (from-to)447-453
Number of pages7
JournalHPB
Volume13
Issue number7
DOIs
StatePublished - Jul 2011
Externally publishedYes

Keywords

  • MELD
  • deceased donation
  • donor risk index
  • liver transplantation
  • marginal donors
  • organ allocation
  • outcomes

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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