Evidence map›Paper›PMID 28573507›Full record

ArticleDigestive diseases and sciences2017

High Center Volume Does Not Mitigate Risk Associated with Using High Donor Risk Organs in Liver Transplantation.

Eliza W Beal, Sylvester M Black, Khalid Mumtaz, Don Hayes, Ashraf El-Hinnawi, Kenneth Washburn, Dmitry Tumin

Registry-linked trialAbstract read
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In one paragraph

Article in Digestive diseases and sciences, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04530240 (Impact of National MELD ≥ 30 Priority Allocation System on Dropout and Post-Transplant Survival Rates in Italy), which is not on this map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04530240 completednot on this map

Impact of National MELD ≥ 30 Priority Allocation System on Dropout and Post-Transplant Survival Rates in Italy: A Retrospective Competing-Risk Analysis

TypeobservationalSponsorUniversity of BolognaRan2010 to 2019Enrolled4,238ConditionsLiver Transplant Disorder, HCCArmsLiver Transplantation
3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Eliza W BealDivision of Transplantation, Department of General Surgery, Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210-1240, USA. Eliza.Beal@osumc.edu.
Sylvester M BlackDivision of Transplantation, Department of General Surgery, Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210-1240, USA.
Khalid MumtazDivision of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
Don HayesDivision of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA.
Ashraf El-HinnawiDivision of Transplantation, Department of General Surgery, Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210-1240, USA.
Kenneth WashburnDivision of Transplantation, Department of General Surgery, Ohio State University Wexner Medical Center, 395 W. 12th Ave., Suite 670, Columbus, OH, 43210-1240, USA.
Dmitry TuminDepartment of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, 43205, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHigh-risk donor allografts increase access to liver transplant, but potentially reduce patient and graft survival.

aimsIt is unclear whether the risk associated with using marginal donor livers is mitigated by increasing center experience.

methodsThe United Network for Organ Sharing registry was queried for adult first-time liver transplant recipients between 2/2002 and 12/2015. High donor risk was defined as donor risk index >1.9, and 1-year patient and graft survival were compared according to donor risk index in small and large centers. Multivariable Cox regression estimated the hazard ratio (HR) associated with using high-risk donor organs, according to a continuous measure of annual center volume.

resultsThe analysis included 51,770 patients. In 67 small and 67 large centers, high donor risk index predicted increased mortality (p = 0.001). In multivariable analysis, high-donor risk index allografts predicted greater mortality hazard at centers performing 20 liver transplants per year (HR 1.35; 95% CI 1.22, 1.49; p < 0.001) and, similarly, at centers performing 70 per year (HR 1.35; 95% CI 1.26, 1.43; p < 0.001). The interaction between high donor risk index and center volume was not statistically significant (p = 0.747), confirming that the risk associated with using marginal donor livers was comparable between smaller and larger centers. Results were consistent when examining graft loss.

conclusionAt both small and large centers, high-risk donor allografts were associated with reduced patient and graft survival after liver transplant. Specific strategies to mitigate the risk of liver transplant involving high-risk donors are needed, in addition to accumulation of center expertise.

Indexed as

Graft SurvivalTissue DonorsAdultFemaleFollow-Up StudiesHospitals, High-VolumeHospitals, Low-VolumeHumansLiver TransplantationMaleMiddle AgedRegistriesRisk FactorsCenter volumeDonor risk indexHigh-volume centersLiver transplantMarginal graft

Identifiers

PMID28573507

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