Centre volume and resource consumption in liver transplantation

UMMS Affiliation

Department of Surgery

Publication Date


Document Type



Liver Transplantation


Health Services Administration | Surgery


BACKGROUND: Using SRTR/UNOS data, it has previously been shown that increased liver transplant centre volume improves graft and patient survival. In the current era of health care reform and pay for performance, the effects of centre volume on quality, utilization and cost are unknown.

METHODS: Using the UHC database (2009-2010), 63 liver transplant centres were identified that were organized into tertiles based on annual centre case volume and stratified by severity of illness (SOI). Utilization endpoints included hospital and intensive care unit (ICU) length of stay (LOS), cost and in-hospital mortality.

RESULTS: In all, 5130 transplants were identified. Mortality was improved at high volume centres (HVC) vs. low volume centres (LVC), 2.9 vs. 3.4%, respectively. HVC had a lower median LOS than LVC (9 vs. 10 days, P < 0.0001), shorter median ICU stay than LVC and medium volume centres (MVC) (2 vs. 3 and 3 days, respectively, P < 0.0001) and lower direct costs than LVC and MVC ($90,946 vs. $98,055 and $101,014, respectively, P < 0.0001); this effect persisted when adjusted for severity of illness.

CONCLUSIONS: This UHC-based cohort shows that increased centre volume results in improved long-term post-liver transplant outcomes and more efficient use of hospital resources thereby lowering the cost. A better understanding of these mechanisms can lead to informed decisions and optimization of the pay for performance model in liver transplantation.


UMCCTS funding

DOI of Published Version



HPB (Oxford). 2012 Aug;14(8):554-9. doi: 10.1111/j.1477-2574.2012.00503.x. Epub 2012 Jun 10. Link to article on publisher's site

Journal/Book/Conference Title

HPB : the official journal of the International Hepato Pancreato Biliary Association

Related Resources

Link to Article in PubMed

PubMed ID