Mayo patients do well before and after liver transplant

Of the 16,000 people on liver transplant lists in the United States, 6,300 undergo transplantation each year, and 1,400 others die waiting. Short- and long-term survival statistics and wait list deaths for more than 100 U.S. transplant centers are easily accessible at the Scientific Registry of Transplant Recipients (SRTR) website.

"Liver transplantation is one of the few areas in medicine where outcomes are closely tracked and measured in a comparable way by the government and other agencies. It's a transparent, objective assessment of center-specific performance that allows patients to make choices that have a major impact on their likelihood of surviving the wait for liver transplantation," notes Michael R. Charlton, M.D., of Mayo Clinic in Minnesota.

SRTR also reports actual outcomes following liver transplantation for each center in comparison to other programs with similar patients as well as national averages. For instance, of 225 adults receiving liver transplants at Mayo Clinic in Rochester, Minn., between Jan. 2009 and June 2011, 93.1 percent were alive at one year. Expected one-year survival was 89.9 percent for similar patients at comparable centers. Observed-to-expected survival ratios were even greater at three years.

According to John J. Poterucha, M.D., also of Mayo Clinic in Minnesota: "One-month and one-year survivals are related more to the surgery itself and after that, a little more to medical care, although you can't really separate the two. Our liver surgeons are excellent. We also have great anesthesiologists and transplant nurses and nonsurgical health workers who see patients after they leave the hospital. It's a team effort."

He adds that having observed survival above the expected and national rates provides a benchmark for comparison with other programs. Comparison is exactly the point of the SRTR data, which, by demonstrating variations among centers, highlight over- and underperforming programs.

Surviving the wait list

Dr. Charlton emphasizes that survival until the time of transplant is as important as post-transplant survival is. "It's fine to have good outcomes after transplant, but you have to live long enough on the transplant wait list to take advantage of that. Looking at the SRTR data, the wait list mortality ranges from 4 percent to 45 percent among transplant centers. I'm pleased that the data for Clinic in Minnesota are the best in the country. We have a demonstrably unique ability to take care of patients before, during and after transplant."

He adds that organ availability doesn't necessarily correlate with wait list mortality. "Some centers with high organ availability have five times the number of wait list deaths as centers with poor access to organs. One of the reasons we have fewer wait list deaths is because we have a vibrant living donor program — one of the largest in the country. Having a successful living donor program is a huge advantage, but we really have the whole package, including easy access to our transplant clinics and hospital teams — if patients feel they need to be seen, we see them straightaway. Program-specific practices for when a patient first arrives in hospital or clinic really make a difference, too. Ultimately, it's important to remember that the best access to organs doesn't mean the best survival. You can have a lot of planes on the runway, but that doesn't mean you can fly them all well."