The volume‐outcomes relationship in donation after circulatory death liver transplantation

Abstract

Background Donation after circulatory death (DCD) liver transplantation (LT) has become an effective mechanism for expanding the donor pool and decreasing waitlist mortality. However, it is unclear if low‐volume DCD centers can achieve comparable outcomes to high‐volume centers. Methods From 2011 to 2019 utilizing the United Network for Organ Sharing (UNOS) database, liver transplant centers were categorized into tertiles based on their annual volume of DCD LTs. Donor selection, recipient selection, and survival outcomes were compared between very‐low volume (VLV, n = 1–2 DCD LTs per year), low‐volume (LV, n = 3–5), and high‐volume (HV, n > 5) centers. Results One hundred and ten centers performed 3273 DCD LTs. VLV‐centers performed 339 (10.4%), LV‐centers performed 627 (19.2%), and HV‐centers performed 2307 (70.4%) LTs. 30‐day, 90‐day, and 1‐year patient and graft survival were significantly increased at HV‐centers (all P < .05). Recipients at HV‐centers had shorter waitlist durations (P < .01) and shorter hospital lengths of stay (P < .01). On multivariable regression, undergoing DCD LT at a VLV‐center or LV‐center was associated with increased 1‐year patient mortality (VLV‐OR:1.73, 1.12–2.69) (LV‐OR: 1.42, 1.01–2.00) and 1‐year graft failure (VLV‐OR: 1.79, 1.24–2.58) (LV‐OR: 1.28, .95–1.72). Discussion Increased annual DCD liver transplant volume is associated with improved patient and graft survival.

Center expansion of liver transplants using donation after circulatory death organs is associated with reduced overall waitlist mortality

“…A recent analysis using UNOS data from 2011 to 2019 by Delman et al concluded that DCD recipients at high‐volume DCD centers had superior survival and decreased waitlist time compared to those at centers with lower DCD volume 15 . Our study provides a natural extension to these findings by demonstrating two key points.…”

“…A recent analysis using UNOS data from 2011 to 2019 by Delman et al concluded that DCD recipients at high-volume DCD centers had superior survival and decreased waitlist time compared to those at centers with lower DCD volume. 15 Our study provides a natural extension to these findings by demonstrating two key points. First, we show that increased DCD use benefits not only DCD recipients but also DBD recipients, though reduced waiting time, waitlist mortality and lower…”

“…DCD livers are known to be associated with lower offer acceptance and procurement rates compared to DBD organs 14 . A recent study by Delman et al highlighted the heterogeneity in DCD LT practices in the United States, yet demonstrated an important volume‐outcome relationship with respect to DCD LT 15 …”

“…12,13 DCD livers are known to be associated with lower offer acceptance and procurement rates compared to DBD organs. 14 A recent study by Delman et al highlighted the heterogeneity in DCD LT practices in the United States, yet demonstrated an important volume-outcome relationship with respect to DCD LT. 15 However, it is unknown whether the potential benefits of increased center DCD use extend beyond DCD recipients, specifically. Further, it is also unknown whether changes in center DCD practice over time (e.g., expansion versus contraction) are associated with waitlist or post-transplant outcomes.…”

Satellite liver transplant centres significantly improve transplant assessment outcomes for patients with chronic liver disease but not hepatocellular carcinoma: a retrospective cohort study

“…However, establishing a new LT centre would require considerable expense and specialist staffing 6. Furthermore, there is an association with low volume LT centres and adverse patient survival so a minimum number of transplants per annum would need to be guaranteed 8 9…”