A rapid increase in liver transplant center volume is associated with favorable waitlist and transplant outcomes: An analysis of unos registry from 2014-2019

Document Type

Conference Proceeding

Publication Date


Publication Title



Background: In liver transplant (LT), center volume may be closely associated with post-LT outcomes. It is unclear if centers can rapidly increase LT volume without compromising their post-LT outcomes. We hypothesized that a rapid increase in LT center volume might be associated with practice changes that could adversely affect post-LT outcomes. This study aims to investigate the effects of a rapid increase in LT center volume on waitlist and post-LT outcomes. Methods: This study uses data from the UNOS registry and evaluated adult patients listed for LT or underwent LT between 2014 and 2019. Patients listed as status 1A, multi-organ transplant, and re-LT were excluded. The change in LT center volume was defined by the LT volume in 2017-19 (late era) minus LT volume in 2014-16 (early era) per center with categorization into three groups: Centers with increased volume (Group A [22 centers]: >60 cases [20 cases/year]), those with equivalent volume (Group B [80 centers]: 0-60 cases), and those with a decline in volume (Group C [36 centers]: <0 case). Ninetyday waitlist mortality (WLM) and LT probability and one-year graft survival were compared between eras in each group. Risks of WLM and graft loss (GL) were analyzed using the Fine-Gray competing risk regression and Cox proportional hazards models. Risk was adjusted by recipient factors at listing for waitlist, and by recipient and donor factors at LT for post-LT analysis. Results: Of 67,046 patients eligible for the analysis of waitlist outcomes, the late era was associated with a significantly lower risk of 90-day WLM than the early era in all groups (Group A: adjusted subdistribution hazard ratio [aSHR] 0.68, P<0.001, Group B: aSHR 0.73, P<0.001, Group C: aSHR 0.79, P<0.001). The late era was associated with a higher 90-day LT probability than the early era in Group A (aSHR 1.44, P<0.001) and B (aSHR 1.08, P<0.001) but not in Group C (aSHR 1.00, P=0.840, Figure 1A and B). Among 39,579 patients eligible for the analysis of post-LT outcomes, the late era was associated with a lower risk of one-year GL in Group A (aHR 0.79, P=0.003) and C (aHR 0.82, P=0.007), whereas the risk was similar to the early era in Group B (aHR 1.00, P=0.95, Figure 1C). Conclusion: A rapid increase in LT center volume was associated with significant improvements in waitlist outcomes, especially increased transplant probability. Transplant practice was expanded in these centers without compromising post-LT outcomes.

PubMed ID

Not assigned.





First Page