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Small liver transplant centers have higher mortality rates-UNOS study.

Centers performing 20 or fewer liver transplants annually have mortality rates that are significantly higher than those of centers doing more than 20 such procedures each year, but the public is unaware of these differences, according to a study in the December 30, 1999 issue of The New England Journal of Medicine.

"The 1-year mortality rate for the low-volume centers [during the period between January 1, 1992 and April 30, 1994] was 25.9%, as compared with 20% for the high-volume centers," reported Erick Edwards, PhD of UNOS and co-authors from the University of California at San Francisco, University Hospitals of Cleveland, Ohio, and the University of Iowa College of Medicine in Iowa City. "Thirteen centers, all of which had low volumes, had 1-year mortality rates that exceeded 40%, and the rate at one of these centers was 100%."

The effect on mortality of the number of procedures performed per year was even greater when low-volume centers affiliated with high-volume centers, such as pediatric transplant programs, were compared with non-affiliated low-volume centers. The 1-year mortality rate for the group of all high-volume centers plus affiliated low-volume centers was 20.1% compared with 28.3% at unaffiliated low-volume centers, according to the investigators.

Presumably, patients requiring liver transplants would steer clear of centers with high mortality rates, if they were informed about survival statistics and had a choice as to where their transplants would be performed. The fact that 837 transplants were done at low-volume centers during the study period suggests "that the information available to patients and referring physicians is inadequate, or that regional health care systems may be forcing patients to go to centers with poor results," the authors concluded. "Information regarding the outcomes of liver transplantation at transplantation centers should be made widely available to the public in a timely manner," they added.

Because organs are distributed geographically, patients at large medical center tend to languish far longer on liver transplant waiting lists than their counterparts at smaller facilities. As a result, the current distribution system creates a perverse incentive that drives people to smaller, less experienced centers, thus propping up institutions with higher mortality rates. The new Department of Health and Human Services regulations, scheduled to take effect in March, could reverse this situation by assuring that scarce livers are available first for the sickest patients, who tend to be cared for a large, high-volume university medical centers.
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Comment:Small liver transplant centers have higher mortality rates-UNOS study.
Publication:Transplant News
Geographic Code:1USA
Date:Jan 14, 2000
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