Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: This study evaluated center performance for wait-list outcomes for adult candidates awaiting liver retransplantation (reLT), and its association with initial liver transplant (iLT) center performance.
*Methods: Using data from the Scientific Registry of Transplant Recipients, center-specific standardized rate ratios (observed / expected) adjusted for recipient and donor factors, and time between transplants were computed for three separate analyses: (i) graft failure (GF), measured from iLT (Figure – Panel A); (ii) reLT (Panel B) and (iii) death (Panel C), each measured from date of post-GF wait-listing. Separate Cox models were used for each analysis, with competing risks methods employed for (ii) and (iii).
*Results: Among 125 transplant centers, 84 (67.2%) had “as-expected” GF rates following iLT, with 19 (15.2%) and 22 (17.6%) centers having better-than- and worse-than-expected outcomes, respectively. There was considerably more heterogeneity in reLT rate (Panel B) and re-waitlist mortality (Panel C) performance than in center iLT GF rates (Panel A). Sixteen of 110 (14.6%) centers performed better-than-expected in terms of reLT rates, while 9 (8.2%) were worse-than-expected. Regarding re-waitlist mortality, there were more than twice as many under-performing centers (20.2%, 19/94) and fewer high-performing centers (10.6%, 10/94). There was no significant correlation between center-specific reLT and reWL performance (r=0.16, p=0.1).
*Conclusions: Center performance for reLT-related outcomes is far more heterogeneous than for iLT. Further research is needed to better understand the factors driving the wide disparity observed in reLT waitlist mortality across centers.
To cite this abstract in AMA style:Bittermann T, Abt PL, Schaubel DE. Center Performance for Liver Retransplantation Candidates is More Heterogeneous Than for Initial Liver Transplantation Recipients [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/center-performance-for-liver-retransplantation-candidates-is-more-heterogeneous-than-for-initial-liver-transplantation-recipients/. Accessed March 6, 2021.
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