Transplant Center Practices Are the Primary Drivers of United States Donation after Circulatory Death Liver Transplantation
1Department of Surgery, Houston Methodist Hospital, Houston, TX, 2Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, TX, 3Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX
Meeting: 2019 American Transplant Congress
Abstract number: 138
Keywords: Donation, Donors, non-heart-beating, Liver transplantation, Resource utilization
Session Information
Session Name: Concurrent Session: Liver: MELD, Allocation and Donor Issues (DCD/ECD) I
Session Type: Concurrent Session
Date: Sunday, June 2, 2019
Session Time: 4:30pm-6:00pm
Presentation Time: 4:30pm-4:42pm
Location: Room 312
*Purpose: We hypothesize that a few high-utilization donation after circulatory death (DCD) liver centers are the primary drivers of the dissimilar rates of DCD liver transplantation (LT) at the donor service area (DSA) level.
*Methods: The Standard Transplant Analysis and Research LT data from 1/1/2013 through 12/31/2017, was retrospectively analyzed. Trends of DCD LT, 3-year mortality, and 3-year graft loss proportion were evaluated using a non-parametric trend test. Kaplan-Meier curves depicted the risk for 3-year mortality and graft loss. Transplant centers were categorized into low volume (<50 DCD LT) and high volume (≥50 DCD LT) centers.
*Results: DCD liver utilization declined during the study period (8.4% of LT in 2013, 6.3% in 2017) despite increasing DCD donor availability (2013: 1,206, 14.6% of deceased donors; 2017: 1,882, 18.3% of deceased donors). 82.5% of US LT centers performed at least 1 DCD LT; however only 10 centers performed ≥50 DCD LTs. (Figures 1a, 1b) The top 4 centers, in 3 DSAs, performed >100 DCD LT, representing 26.7% of all DCD LT. The 10 high volume centers represented 8 different DSAs and performed 42.9% of US DCD LT. Kaplan Meier statistic and univariate Cox regression found no statistically significant difference in 3-year patient nor graft survival between the low and the high-volume centers.
*Conclusions: 8.8% of US LT centers represent >42% of the total DCD LT volume. These high-volume centers represent 8 different DSAs, suggesting center behavior, not donor availability, drives this aggressive utilization. Low and high-volume centers obtain equivalent 3-year graft survival, suggesting that poor outcomes may not be a true barrier preventing low-volume centers from expanding DCD LT offerings. Advanced surgeon and center education may encourage low-volume centers to utilize DCD LT more frequently, increasing the number of LT performed and reducing wait-list mortality. Future studies will examine donor and recipient risk factors relative to graft and patient survival by center within DSAs. Figure 1a. Number of US DCD Donor Liver Transplants by Center by Volume, 01/2013 – 12/2017 (N=2,285)
Figure 1b. Frequency of DCD Donor Liver Transplant, by DCD Transplant Volume <50 vs >=50
To cite this abstract in AMA style:
Beal L, Nguyen DT, Menser T, Zajac S, Graviss EA, Hobeika MJ. Transplant Center Practices Are the Primary Drivers of United States Donation after Circulatory Death Liver Transplantation [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/transplant-center-practices-are-the-primary-drivers-of-united-states-donation-after-circulatory-death-liver-transplantation/. Accessed May 18, 2025.« Back to 2019 American Transplant Congress