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Registry: UPMC liver transplant outcomes languish

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Wednesday, Jan. 18, 2012

UPMC's liver transplant program had a second consecutive period in which more patients than expected died but is taking steps to revise its operating procedures and review its reporting practices, a top surgeon said on Monday.

Out of 261 people who received a liver transplant at UPMC between July 2008 and December 2010, 42 died within a year of the surgery, according to the latest filing by the Scientific Registry of Transplant Recipients, which conducts scientific performance analysis of data about organ transplant programs at hospitals nationwide. Based on the number of UPMC surgeries and the patients' conditions, the registry said fewer than 29 people were expected to die.

Despite the lower-than-expected survival rate, the hospital has not shied away from taking difficult cases, said Dr. Christopher Hughes, UPMC's surgical director for liver transplants.

"We want Pittsburgh to be known as the place," Hughes said. "If it's a really bad situation you're in, UPMC is the place you should go. We don't want to become a program that is cherry-picking patients just to make our data look good."

The registry's report emerges after a tumultuous period last year for UPMC's transplant programs but reflects surgeries that took place more than a year ago. UPMC shut its live-donor liver and kidney transplant programs for nearly nine weeks last summer after surgeons inadvertently transplanted a kidney from a donor infected with hepatitis C and transferred the disease to the recipient.

Hughes said no one who received a liver transplant at UPMC during the past six months has died or rejected the organ, but that success will not start to be reflected in the data until a year from now.

The registry reported that survival outcomes for kidney and heart transplants at UPMC were within expected ranges.

UPMC is looking at how it reports patients' conditions because its expected outcomes have increased even as it has taken patients with more challenging cases, Hughes said.

He cited a case in which a patient who needed heart surgery and a liver transplant at the same time came to UPMC after other hospitals turned her away. The woman survived, but the unique circumstances that put her at an increased risk of death were not fully reflected in the reports that determine expected outcomes, Hughes said.

The hospital also has worked to standardize the steps it takes to evaluate patients and perform transplant surgeries, he said.

Across the Allegheny River, Allegheny General Hospital had liver and kidney transplant outcomes in the expected range while recording the state's highest one-year survival rate for adult heart transplant recipients -- 96 percent.

"We're going to keep doing exactly what we've been doing," said Dr. Ngoc Thai, director of abdominal transplants at the North Side hospital, flagship of UPMC rival West Penn Allegheny Health System.

Allegheny General has focused on rebuilding its transplant programs over the past several years, taking the number of heart transplants from low single digits -- four transplants in 2005 -- to a peak of 31 in 2010, said Dr. Stephen Bailey, surgical director of the heart transplant program. The number dipped to 20 last year.

"It's been an area of focused investment, mostly human investment," Bailey said. "Recruiting top quality physicians and coordinators in associated fields over the last five years has led to the good results recently."

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