Liver Transplant
Quality Measures

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Liver Transplantation – Quality Measures

Accurately measuring and critically reviewing outcomes data are the first steps in continuous quality improvement. Our liver transplant team is committed to not only reviewing, but sharing our outcomes with patients, families and the transplant community.  We believe this philosophy helps create an open, collaborative environment in which sharing of knowledge and best practices will improve the care for all children undergoing liver transplantation.

U.S. News & World Report consistently ranks the Division of Gastroenterology at Cincinnati Children’s among the nation’s top programs in its annual guide of “Best Children’s Hospitals.” 

Integral to the gastroenterology program is the Liver Transplant Program. To achieve the best outcomes, we have assembled dedicated teams that track a variety of measures, each aimed at improving care before and after liver transplantation. Measures we currently report include:

    • Number of transplants performed each year
    • Overall patient and graft survival following liver transplantation
    • Mortality while on the wait list and median time to transplant
    • Volume and outcomes for pediatric liver tumor transplants 

On this page you can learn more about our performance and how we are working to “Change the Outcome” for patients and their families. The statistics are from the Scientific Registry of Transplant Recipients (SRTR), a national database.

Note: “United States / National” data are for illustration only.  Based on the unique mix of patients served by a transplant program, and the large difference in numbers between patients transplanted or on the wait list at an individual program and ALL patients transplanted or on the wait list across the country, the numbers and rates may not be directly comparable.

Our Performance

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  • Since its founding in 1985, the Liver Transplant Program at Cincinnati Children’s has performed more than 530 pediatric liver transplants. More than 300 of these patients receive continued follow-up by our program. 
  • Cincinnati Children’s is one of the top six pediatric liver transplant programs in the country in terms of number of transplants per year and total number of transplants performed.

Patient Survival

How We Measure 

Patient survival represents the patients who are alive at a given time after transplant (30 days, one year and three years).  Because each transplant center serves patients with varying levels of complexity, the SRTR takes into account a number of factors when calculating the “expected” survival rate for an individual center.  This calculation is called “risk adjustment” and accounts for specific patient and donor characteristics such as the age and weight of the donor, the type of liver graft (whole or partial) and the presence of complications of end-stage liver disease in the transplant recipient.

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  • Patient survival at 30 days after liver transplantation is largely a reflection of clinical status at the time of transplant.  To closely monitor patients’ status while waiting to receive their transplant, we schedule regular clinic visits (every one to three months).  We believe that aggressive pre-transplant management of nutrition, prevention of infection and early intervention for complications of end-stage liver disease are critical factors in achieving and maintaining 100 percent survival at 30 days after transplant.
  • Patient survival three years after liver transplantation is a more complicated measure.  Variables that can adversely impact long-term outcome and threaten long-term survival include recurrence of primary disease, dysfunction of organs other than the liver (heart, lungs or immune system), poor adherence to medications and complications of long-term immunosuppression.  At Cincinnati Children’s, we believe that every child, even those who are less likely to have a “perfect” outcome, deserves a chance.  We are committed to improving long-term outcomes while continuing to provide life-saving liver transplantation to the most complicated patients.

Graft (or Transplanted Organ) Survival

How We Measure

Graft survival represents the patients who are alive with a functioning liver transplant at a given time after transplant (30 days, one year and three years). As with patient survival, the SRTR risk adjusts for expected graft survival. This helps account for center-to-center differences and complexity in patient populations and allows for better comparisons of performance on key outcomes among transplant centers. 

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  • Receiving a liver transplant is both a life-saving experience and a life-long commitment.  Keeping a liver graft functioning and the transplant recipient happy and healthy require an ongoing partnership among the patient, the family and the transplant team. One of our primary areas of focus at Cincinnati Children’s is long-term liver transplant outcomes. This includes the prevention of medication-induced kidney dysfunction, minimization of immunosuppression and ensuring the highest quality of life possible for our patients.

Patient Mortality While on the Liver Transplant Wait List

According to previous program -specific SRTR reports for the time period between 1/1/2008 and 06/30/2010, the percentage of patients who died on the waiting list (without liver transplant) has ranged from 2.3% to 8.7%.  From 7/1/2012 to 6/30/2013, no patients awaiting primary liver transplant died on the waiting list.

How We Measure

Mortality on the waiting list is defined as the percentage of patients on a transplant center’s waiting list who die over a given period of time (six months, 12 months, 18 months) after being placed on the list.  

> See Scientific Registry of Transplant Recipients report.


  • Even one death on the transplant waiting list is unacceptable.  Our pre-transplant management program and our active living donor transplant program are designed to eliminate deaths on the waiting list by aggressive prevention and management of medical complications before the transplant.

Median Wait Time Until Transplant

According to previous program-specific SRTR reports for the time period between 7/1/2004 and 12/31/2012, the median months on the waitlist before transplant has ranged from 3.6 to 4.0 months.

How We Measure

The median is the middle value in a series of numbers arranged in order from lowest to highest. Half of these numbers are higher than the median and half are lower.  The median wait time for a liver transplant is a good reflection of actual patient experience as it is less likely to be affected by very short wait times (for example, one day) or very long wait times (for example, four years).

quality-measures-liver-waitlist-time

  • The amount of time a patient spends waiting for a liver transplant is highly variable.  Important considerations include patient size, blood type and availability of organs, which varies greatly from one region to another (there are 11 transplant regions across the United States). 
  • The current system for allocating organs is based on the concept of “sickest first.” The model for end stage liver disease (MELD for ages 12 and older) and the pediatric end stage liver disease model (PELD for ages 11 and younger) use a variety of patient characteristics to determine position on the wait list. Managing all of these variables such that each patient gets transplanted in a timely manner requires close partnership between the transplant program and the patient  and family.

Visit the MELD / PELD Calculator for More Information

 

Volume

One of the novel areas in which the program at Cincinnati Children’s excels is transplantation for pediatric liver tumors*.  Since 2007, we have performed more transplants for pediatric liver tumors than any other program in North America (28 liver transplants from January 2007 to May 2013)**.  

quality-measures-liver-oncology-volume

*Includes hepatoblastoma, hepatoma, hepatocellular carcinoma and other specific liver tumors; does not include hemangioendothelioma

**Source: Organ Procurement and Transplantation Network (OPTN) data as of May 2013

Patient and Graft Survival

Our results for post-transplant patient and graft survival for children with liver tumors have been excellent.  We believe our ability to achieve these outcomes is based on our comprehensive and multidisciplinary approach to management of pediatric liver tumors. This approach includes close collaboration among a variety of specialists and includes: Pediatric Oncology, Pediatric Surgery, Pediatric Transplant Hepatology, Pediatric Pathology and Pediatric Radiology. 

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> Learn More about Our Unique Liver Tumor Program

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