title: Effect of centre volume and high donor risk index on liver allograft survival.
abstract: BACKGROUND
  A growth in the utilization of high-risk allografts is reflective of a critical national shortage and the increasing waiting list mortality. Using risk-adjusted models, the aim of the present study was to determine whether a volume-outcome relationship existed among liver transplants at high risk for allograft failure.
  
  
  METHODS
  From 2002 to 2008, the Scientific Registry of Transplant Recipients (SRTR) database for all adult deceased donor liver transplants (n = 31 587) was queried. Transplant centres (n = 102) were categorized by volume into tertiles: low (LVC; 31 cases/year), medium (MVC: 64 cases/year) and high (HVC: 102 cases/year). Donor risk comparison groups were stratified by quartiles of the Donor Risk Index (DRI) spectrum: low risk (DRI ≤ 1.63), moderate risk (1.64 > DRI > 1.90), high risk (1.91 > DRI > 2.26) and very high risk (DRI ≥ 2.27).
  
  
  RESULTS
  HVC more frequently used higher-risk livers (median DRI: LVC: 1.82, MVC: 1.90, HVC: 1.97; P < 0.0001) and achieved better risk adjusted allograft survival outcomes compared with LVC (HR: 0.90, 95%CI: 0.85-0.95). For high and very high risk groups, transplantation at a HVC did contribute to improved graft survival [high risk: hazard ratio (HR): 0.85, 95% confidence interval (CI): 0.76-0.96; Very High Risk: HR: 0.88, 95%CI: 0.78-0.99].
  
  
  CONCLUSIONS
  While DRI remains an important aspect of allograft survival prediction models, liver transplantation at a HVC appears to result in improved allograft survival with high and very high risk DRI organs compared with LVC.
authors.affiliation: Department of Surgery, Surgical Outcomes Analysis & Research, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Ozhathil
authors.forename: Youfu
authors.initials: Y
authors.lastname: Li
authors.forename: Jillian K
authors.initials: JK
authors.lastname: Smith
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Tseng
authors.forename: Reza F
authors.initials: RF
authors.lastname: Saidi
authors.forename: Adel
authors.initials: A
authors.lastname: Bozorgzadeh
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
mesh_terms: D000328:Adult; D005260:Female; D006085:Graft Survival; D006748:Hospital Departments / Q000706:statistics & numerical data; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D012307:Risk Factors; D014184:Transplantation, Homologous; D019737:Transplants / Q000706:statistics & numerical data*; D014481:United States; D014850:Waiting Lists / Q000401:mortality*