Liver Transplant

A liver transplant is a surgical procedure to remove a diseased liver and replace it with a healthy liver from a donor. Most liver transplant operations use livers from deceased donors, though a liver may also come from a living donor.

Liver transplant is a treatment option for people who have liver failure that cannot be controlled using other treatments and for some people with liver cancer. Liver failure has many causes, including cirrhosis, early-stage liver cancer, chronic hepatitis C, hemochromatosis (too much iron absorbed by the liver) and Wilson's disease (too much copper absorbed by the liver).

The number of people waiting for liver transplant is much larger than the number of available livers, so liver transplant is reserved for people who are critically ill. Some people may spend months waiting for a liver transplant.

Procedure volume is the number of times a procedure was performed and is often used to assess clinical experience and expertise. Studies have linked higher volumes with more successful outcomes for some types of procedures.

Number of Liver Transplants

Details

Why is This Measure Important?

Health systems that perform a high number of liver transplants are more likely to have better outcomes, such as better survival rates. Unfortunately, there is no agreed upon standard or threshold that defines high volume so it is important to consider volume along with other measures, like process and outcome measures. This is a measure of the volume, or number of liver transplants.

How is UMHS Performing?

Surgeons at the University of Michigan Health System perform between 75 and 80 liver transplants each year. According to the U.S. Scientific Registry of Transplant Recipients, typical liver transplant programs in the United States have a transplant rate of 38.9%, the rate at UMHS is 47%. Our volume is high compared to volume at other health systems, demonstrating that UMHS has considerable experience in liver transplantation.

UMHS Source: Hospital administrative data.
Comparison Group Source: None.

The following graph can be used to assess our efforts to reduce the time from evaluating a potential transplant candidate to putting him/her on the transplant waiting list.

Time from Patient Evaluation to Waiting List
Lower Value = Better Performance

Details

Why is This Measure Important?

It takes time for a liver transplant candidate to receive a liver from a donor. As a consequence, it is important to minimize the time from evaluating a potential transplant candidate to putting him/her on the transplant waiting list. This is a measure of the time from evaluation to listing for liver transplant candidates.

How is UMHS Performing?

Though the graph shows that median number of days from evaluation to wait listing a patient for transplant is variable, performance at the University of Michigan Health System. We continue to monitor this measure and improve efficiency of this process as needed.

UMHS Source: Hospital Organ Transplant Information System.
Comparison Group Source: Institutional goal set by UMHS.

In this section, we evaluate the success of the liver transplants by measuring several outcomes, including patient and graft survival. Because the severity of disease differs between patients, some patients have a higher risk of death. So, we compare our actual performance to what is expected given the risk of the patients we treat. The expected survival rate is provided by the U.S. Scientific Registry of Transplant Recipients (SRTR). For all measures except waitlist mortality, percentages that are higher than the SRTR expected rate mean better performance.

Transplant Rate
Higher Value = Better Performance

Details

Why is This Measure Important?

The transplant rate is the percentage of patients on the waiting list for transplant who received a transplant. The actual transplant rate for the University of Michigan Health System is compared to the expected rate for our institution calculated by the US Scientific Registry for Transplant Recipients (SRTR). Although the SRTR expected rates are adjusted to account for the severity of illness of our waitlisted patients, the adjustment is not perfect. In this graph, a percentage that is higher than the SRTR expected rate means better performance.

(Note: The rate accounts for the amount of time patients are waitlisted and is expressed as the number of transplants per patient year on the waiting list.)

How is UMHS Performing?

The University of Michigan Health System performed more transplants than expected based on the national experience in all four years reported. The difference between actual and expected rates from 2008 - 2011 were statistically significant.

UMHS Source: Hospital Organ Transplant Information System.
Comparison Group Source: Scientific Registry of Transplant Recipients (SRTR).

Patient Survival Rates After Transplant - Adults
Higher Value = Better Performance

Details

Why is This Measure Important?

Patient survival is a measure of the success of the liver transplant. This measure represents the percentage of adult patients who survived 1 month, 1 year and 3 years after liver transplant. The actual patient survival rates for the University of Michigan Health System are compared to the expected rates for our institution calculated by the U.S. Scientific Registry for Transplant Recipients (SRTR). Although the SRTR expected rates are adjusted to account for the severity of illness of our transplant population, the adjustment is not perfect. In this graph, a percentage that is higher than the SRTR expected rate means better performance.

How is UMHS Performing?

The University of Michigan Health System's adult patient survival rate is higher than expected after 1 month but is lower than expected at 1 and 3 years after liver transplant, based on results from SRTR. The differences in these rates were not statistically significant.

UMHS Source: Hospital Organ Transplant Information System.
Comparison Group Source: Scientific Registry of Transplant Recipients (SRTR); 1-month and 1-year survival is reported for patients who received a transplant from Jan '09 - Jun '11 and 3-year survival is reported for patients who received a transplant from Jul '06 - Dec '08.

Waitlist Mortality
Lower Value = Better Performance

Details

Why is This Measure Important?

This is a measure of the number of patients who died while waiting for a transplant. The results for this measure may be influenced by the characteristics of the patients on the waitlist and availability of organs from suitable donors. The actual waitlist mortality rate for the University of Michigan Health System is compared to the expected rate for our institution calculated by the U.S. Scientific Registry for Transplant Recipients (SRTR). Although the SRTR expected rates are adjusted to account for the severity of illness of our waitlisted patients, the adjustment is not perfect. In this graph, a percentage that is lower than the SRTR expected rate means better performance.

(Note: The rate accounts for the amount of time patients are waitlisted and is expressed as the number of deaths per 1,000 patient years on the waiting list.)

How is UMHS Performing?

The University of Michigan Health System had slightly higher mortality than expected based on the national experience from 2008 - 2011. However, the difference between actual and expected rates in all four years is not statistically significant.

UMHS Source: Hospital Organ Transplant Information System.
Comparison Group Source: Scientific Registry of Transplant Recipients (SRTR).

Graft Survival Rates After Transplant - Adults
Higher Value = Better Performance

Details

Why is This Measure Important?

A "graft" refers to the transplanted organ. Graft survival is a measure of the success of the liver transplant. Sometimes the transplant, or graft, may fail, but the person may survive. This measure represents the percentage of grafts for adult patients that survived 1 month, 1 year and 3 years after liver transplant. The actual graft survival rate for the University of Michigan Health System is compared to the expected rate for our institution calculated by the U.S. Scientific Registry for Transplant Recipients (SRTR). Although the SRTR expected rates are adjusted to account for the severity of illness of our transplant population, the adjustment is not perfect. In this graph, a percentage that is higher than the SRTR expected rate means better performance.

How is UMHS Performing?

The University of Michigan Health System's graft survival rate is about the same as expected after 1 month and 1 year but is lower than expected at 3-years after liver transplant, based on results from SRTR. The differences in these rates were not statistically significant.

UMHS Source: Hospital Organ Transplant Information System.
Comparison Group Source: Scientific Registry of Transplant Recipients (SRTR); 1 month and 1 year survival is reported for patients who received a transplant from Jan '09 - Jun '11 and 3 year survival is reported for patients who received a transplant from Jul '06 - Dec '08.