title: Association between liver transplant center performance evaluations and transplant volume.
abstract: There has been increased oversight of transplant centers and stagnation in liver transplantation nationally in recent years. We hypothesized that centers that received low performance (LP) evaluations were more likely to alter protocols, resulting in reduced rates of transplants and patients placed on the waiting list. We evaluated the association of LP evaluations and transplant activity among liver transplant centers in the United States using national Scientific Registry of Transplant Recipients data (January 2007 to July 2012). We compared the average change in recipient and candidate volume and donor and patient characteristics based on whether the centers received LP evaluations. Of 92 eligible centers, 27 (29%) received at least one LP evaluation. Centers without an LP evaluation (n = 65) had an average increase of 9.3 transplants and 14.9 candidates while LP centers had an average decrease of 39.9 transplants (p < 0.01) and 67.3 candidates (p < 0.01). LP centers reduced the use of older donors, donations with longer cold ischemia, and donations after cardiac death (p-values < 0.01). There was no association between the change in transplant volume and measured performance (R(2)  = 0.002, p = 0.91). Findings indicate a strong association between performance evaluations and changes in candidate listings and transplants among liver transplant centers, with no measurable improvement in outcomes associated with reduction in transplant volume.
authors.affiliation: Digestive Disease Institute, Cleveland Clinic, Cleveland, OH; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors.forename: L D
authors.initials: LD
authors.lastname: Buccini
authors.forename: D L
authors.initials: DL
authors.lastname: Segev
authors.forename: J
authors.initials: J
authors.lastname: Fung
authors.forename: C
authors.initials: C
authors.lastname: Miller
authors.forename: D
authors.initials: D
authors.lastname: Kelly
authors.forename: C
authors.initials: C
authors.lastname: Quintini
authors.forename: J D
authors.initials: JD
authors.lastname: Schold
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D013531:Surgicenters / Q000592:standards* / Q000706:statistics & numerical data*; D014481:United States; D014850:Waiting Lists
keywords: Donors and donation: extended criteria; Scientific Registry for Transplant Recipients (SRTR); ethics and public policy; graft survival; health services and outcomes research; liver transplantation/hepatology; organ procurement and allocation; patient survival; quality of care/care delivery