For patients in need of a liver transplant, their choice of a transplant center can make a noteworthy difference in their outcomes, according to a Mayo Clinic study presented at the American Transplant Congress under way May 1-5 in San Diego.
"We did find significant variation between centers in patient outcomes in the first year after transplant," says Ray Kim, M.D., one of the lead investigators on the study. Previous studies have looked at outcomes based on factors about the recipients and donors involved, but no known previous study has focused on what effect the transplant center could have on patient outcomes.
Researchers documented an average 30 percent difference in risk for failed transplant between centers. Between centers with the best and worst outcomes, there may be as much as a fourfold difference in risk. Failed transplant was defined as either patient death or the need for a subsequent liver transplant within a year. "Though one intuitively expects a certain amount of difference between centers, this effect seems larger than previously thought. The bottom line for patients: do your homework before selecting a transplant center," he says.
But transplant center size alone, measured in patient volume, didn't account for the difference in outcomes. "Results showed that the number of transplants performed didn't materially affect outcomes," says Dr. Kim. "This implies the largest center won't necessarily have the best results. Similarly, a smaller center may deliver similar outcomes."
Using data from the Organ Procurement and Transplantation Network, Mayo Clinic researchers reviewed data from 12,233 patients who received liver transplants to treat chronic liver disease. The data included transplants performed at more than 100 U.S. hospitals that performed at least one liver transplantation surgery from 2005 to 2008.
Of those transplants, 15 percent failed within a year. The outcome differences between transplant centers were greatest during the first three months post-transplant.
Data used in the study was combined and analyzed without naming the transplant centers. "The goal of the research is not to point fingers," says Dr. Kim. "The study was undertaken with the hope of finding ways for the transplant community to make the best use of a very limited resource, namely the donated organs. The data clearly showed that where the transplantation is done makes a difference whether the outcome of a transplant will be successful." In the United States, nearly 16,000 people are waiting for liver transplants.
Dr. Kim notes that there may be several ways transplant center factors can affect transplant outcomes. The most immediate factor is quality of care provided at the center, including surgical, medical and nursing expertise. In addition, how patients and donor organs are selected for transplantation also contributes to the outcome. And last, where the center is located geographically has a substantial impact on availability and quality of donated organs.
Patients who need information about any type of solid organ transplant can find outcomes and statistics by individual transplant centers at the Scientific Registry of Transplant Recipients (www.ustransplant.org). The SRTR is administered by the Arbor Research Collaborative for Health with the University of Michigan, with oversight and funding from the Health Resources and Services Administration. Data are adjusted for organ health and the health status of the recipient to provide an objective comparison of outcomes.
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