BACKGROUND: The decision to accept or decline a liver allograft for a patient on the transplant waiting list is complex. We hypothesized that surgeons are not accurate at predicting donor-specific risk. METHODS: Surgeon members of the American Society of Transplant Surgeons were invited to complete a survey in which they predicted 3-year risk of graft failure for a 53 year old man with alcoholic cirrhosis and MELD 21, with a liver from each of the following donors: 1) 30 year old local donor with traumatic brain death, or 2) 64 year old regional donor with brain death from stroke. RESULTS: Complete responses were obtained from 201 surgeons whose self-reported case volume represents 97% of liver transplants in the U.S. Surgeon-predicted 3-year graft failure risk varied widely, as shown in the histograms below with overlaid normal distribution curves. In scenario 1, 90% of respondents provided lower estimates of graft failure risk than the literature-derived estimate of 21%. In scenario 2, 96% of responses were lower than the literature-derived estimate of 40%. There was a bimodal distribution regarding the role of visual inspection of the donor liver in the decision to transplant a particular organ; two-thirds of respondents replied that visual inspection played a critical role in 10%-30% of cases, while one-fifth replied that it played a critical role in 80%-100% of cases. CONCLUSION: Surgeons vary widely in their predictions of donor-specific risk of graft failure. We have demonstrated systematic bias towards inaccurately low estimates of graft failure particularly for higher risk organs. These findings provide impetus for development of decision support tools for organ offers.
Surgeon estimate of graft failure risk; vertical dotted line shows literature estimate (Feng et al. AJT 2006).
To cite this abstract in AMA style:Volk M, Merion R. Systematic Bias in Surgeon Predictions of Donor-Specific Risk of Liver Transplant Graft Failure [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/systematic-bias-in-surgeon-predictions-of-donor-specific-risk-of-liver-transplant-graft-failure/. Accessed May 17, 2021.
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