Liver Transplant Center Size and the Impact on Clinical Outcomes and Resource Utilization.

Background: Prior studies suggest that transplant center volume is associated with liver transplantation (LT) outcomes. We compared patient characteristics and waitlist outcomes among transplant centers in the United States with different volumes.

Methods: Data for adult waitlisted candidates and LT recipients in the United States between 2008 and 2017 were extracted from the Scientific Registry of Transplant Recipients database. Transplant centers were categorized by transplants/year into tertiles: low-volume centers (LVCs; <20 transplantations/y); medium-volume centers (MVCs; 20-55 transplantations/y); and high-volume centers (HVCs; >55 transplantations/y). Patient characteristics, waitlist outcomes, and factors associated with posttransplantation mortality were compared.

Results: From 141 centers, 112 110 patients were waitlisted for LT: 6% at LVCs, 26% at MVCs, and 68% at HVCs. Patients listed at LVCs were less likely to have private insurance but had higher Medicaid and Veterans Affairs healthcare rates. Patients at LVCs were less likely to receive LT (47% versus 53% in MVC versus 61% in HVC), had higher transfer rates to other centers, and were more likely to be removed from the waitlist. In competing risk survival analysis, adjusted for center location, MELD score, and clinicodemographic factors, patients listed at an HVC were more likely to receive LT (adjusted hazard ratio:1.30; 95% confidence interval = 1.27-1.33; P < 0.001). Among LT recipients (n = 62 131), receiving a transplant at an LVC was associated with higher post-LT mortality (adjusted hazard ratio: 1.16; 95% confidence interval = 1.05-1.28; P = 0.003).

Conclusions: Patients at LVCs were less likely to receive a LT and had a higher risk of post-LT death.