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Program and OPO Specific Reports
, July 2010
Report Published
July 2010
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Full Report (PDF) for this center
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User's Guide
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Questions about our methodology?
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Loma Linda University Medical Center, Loma Linda, CA(LI)
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| A Guide to Reading and Understanding the Center-Specific
Reports (CSRs) Prepared by the Scientific Registry of Transplant Recipients (SRTR) |
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| Center:
Loma Linda University Medical Center (CALL) |
| Organ:
LI: Liver |
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| Overview: |
These Program-Specific Reports contain a wide range of useful information
about transplant programs operating in the United States. The information
includes many features of the transplant program, such as the number of
transplants performed in recent years, waiting time and waiting list
outcomes, and post-transplant experience of patients served by this program.
The statistics are arranged to allow comparisons to national averages, as
well as to the experience for similar patients at other programs in the
country. This report is based largely on data submitted by this transplant
program for patients on the waiting list and those transplanted within the
last five years. |
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Table 1 provides a picture of the volume and type of waiting list and
transplant activity at this program. Loma Linda University Medical Center
(CALL) had 124 patients on its waiting list on 01/01/2008 and 175 patients on
12/31/2009. During these two years, 179 patients were added to the list and
128 patients were removed. Of the removals, 43 were for transplant from a
deceased donor. Loma Linda University Medical Center (CALL) performed 21
liver transplants (Table 7) during the last year (01/01/2009-12/31/2009).
Typical liver programs currently operating in the United States transplanted
between 17 and 66 people in that same period. More about the activity at this
program and the types of patients served is found in the Table Details
section below and in Tables 1 and 2 (waiting list) and Tables 7, 8, and 9
(transplant). |
The likelihood of receiving a liver transplant differs from facility to
facility and also from person to person depending upon the medical condition
of the candidate. Overall, at Loma Linda University Medical Center (CALL),
16.0 percent of patients placed on the waiting list had received a transplant
by 6 months after listing, compared with 42.3 in the nation (Table 4). At 6
months, 4.0 percent had died (compared to 6.3 nationally) and 62.7 were still
on the waiting list (43.5 nationally). These numbers are strongly influenced
by the proportion of patients who are listed at a high medical urgency
status. At this program, 5 of 75 of these patients were listed at Status 1.
For these most urgent patients, 20.0 percent had received a transplant by 6
months after listing, compared with 60.3 in the nation (Table 4S1). At 6
months, 40.0 percent had died (10.3 nationally) and 0.0 were still on the
waiting list (4.6 nationally). |
Other measures of waiting list outcomes are discussed below and shown in
Tables 3 - 6. |
At Loma Linda University Medical Center (CALL), 84.57 percent of adult
patients were alive one year after transplant, compared to the 92.04 percent
that would be expected based on the characteristics of these patients.
However, the p-value of 0.104 indicates that the difference between these
rates is not statistically significant. Similar comparisons may be made for
shorter- (1 month) and longer-term (3 year) survival, also in Table 11, as
well as for graft survival (Table 10). Further discussion of actual,
expected, and national survival rates may be found in the Table Details
section below. |
The above results reflect survival for both deceased and living donor
transplants combined. Of these 56 adult transplants performed by Loma Linda
University Medical Center (CALL), 56 were deceased donor transplants, and
84.57 percent of these recipients remained alive one year later. |
Specific circumstances at each program may affect many of the measures
reported in these reports. Frequently, staff from transplant programs make
public comments regarding these reports, made available in the comments page.
We encourage all readers of these reports to consider these comments and to
contact the program directly for further information. |
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Table Details: |
The above overview provides most readers with a quick look at some of the
statistics that help describe a transplant program. The following section,
for the more interested reader, provides a more detailed accounting of each
table and how figures are defined and calculated. |
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Tables 1 through 6 focus on characteristics of the waiting list process at
this program. Table 1 provides an overview of the waiting list activity at
this program: not just the size of the waiting list at a given point in time,
but also how many people have moved on to and off of this waiting list, and
for what reasons. Shown as a percentage of the total waiting list size on
01/01/2009, the percent of people removed for a transplant from a deceased
donor was 14.0%, (vs. 37.3% nationwide) and the percentage of people removed
because of death was 6.0% (vs. 9.2% nationwide). Table 2 shows the
characteristics of patients on the waiting list at Loma Linda University
Medical Center (CALL). |
The waiting time at a given transplant program is affected by many factors,
including the medical condition and characteristics of the patients listed
with this program (Table 2), the availability of organs in the Donation
Service Area served by the OPO, and decisions by medical professionals and
other patients about organ acceptance. Some of the variability in waiting
time may be accounted for by local availability of organs, in which case
other programs in the Donation Service Area served by OneLegacy may have
similar waiting times. |
Tables 3 through 6 provide different measures of looking at waiting list
outcomes. Table 3 shows a 'risk-adjusted' comparison of two outcomes from the
waiting list: transplant rate and death rate. While the national average
transplant rate (from deceased donors) is 0.38 transplants per patient year,
the rate expected for this program is 0.45. The difference, or 'adjustment',
between the national average and expected rate is caused by the fact that
this program may treat patients who typically have longer (or shorter)
waiting times, based on the characteristics of these patients. The patients
on the waiting list at this program experienced a transplant rate of 0.13 per
year spent on the waiting list for any person(s) on the waiting list. Compared
to the expected rate of 0.45, the difference is unlikely to have occured by
random chance (p<.01) and probably represents a real difference from the
expected rate. |
These waiting list rates are measured as the number of transplants (or
deaths) per year that any patient spends on the waiting list. It is possible
for these rates to be above 1, as would be the case if 2 patients each spent
3 months on the waiting list, and one received a transplant: 1 transplant
divided by .5 year = transplant rate of 2. |
While Table 3 provides a waiting list outcome rate that allows easy
comparison of risk-adjusted outcomes, statistics from tables 4 through 6 may
be more interpretable at a patient level. Table 4 answers the questions:
'What has been the outcome for patients at this program 6 months after being
placed on the waiting list? What about at 12 or 18 months?' The table also
examines post-transplant outcomes: at 12 months, for example, the table tells
if the patient is still on the waiting list, was transplanted and is still
alive, or died after transplant. Outcomes from this table are described above
in the 'Overview' section. |
Table 5 provides another way to look at how quickly patients receive
transplants at this program, this time looking at many different kinds of
patients. At this program, 15.5 percent of patients placed on the liver
waiting list had received transplants as of 30 days after being placed on the
waiting list. Those not transplanted, the other 84.5 percent, were either
still waiting or removed from the waiting list for reasons including death.
At one year after placement on the waiting list, 32.5 percent of patients at
this program had been transplanted; this figure was 47.7 for all the programs
in the nation. The table also shows similar figures for subgroups of
patients, such as by age, disease, or medical urgency, allowing the reader to
see if specific groups of patients have experienced longer waiting times. |
Table 6 shows the time it takes for a given percentage of patients at this
facility to receive a transplant. This is the 'time-to-transplant' among all
wait-listed patients, including those who never receive a transplant. One
quarter of the patients placed on the waiting list at this program had
received a transplant as of 8.0 months after listing; in the nation it took
1.3 months to reach the same fraction. The other three quarters of the
patients were either still waiting or removed from the waiting list, for
reasons including death. (Another common statistic, 'median waiting time,'
differs in that it is often calculated only among patients who actually
received a transplant. The two are often correlated, but different in
magnitude. While median waiting time reflects time waiting among successful
candidates, time-to-transplant incorporates a measure of the probability of
success in receiving an organ.) |
The remainder of the tables, 7 through 11, focus on transplants performed
at Loma Linda University Medical Center (CALL) and their outcomes. Tables 7-9
describe the characteristics of transplant recipients, donors, and operations
at this program. For example, of the 21 patients receiving deceased donor
transplants at this program in the last year, 85.7 percent had organ failure
caused by Non-Cholestatic Cirrhosis, compared to a national average of 58.1
percent. |
Tables 10 and 11 show post-transplant outcomes. Table 10 shows the survival
experience of grafts (transplants) in patients transplanted by this program.
Table 11 shows the survival experience of these patients themselves. These
may be different because a patient may continue survival after a graft fails
through means such as a new transplant, or, for kidney patients, dialysis.
For each outcome, these tables show an actual (observed) survival for the
program, an actual (observed) survival for the nation, and an expected
survival for the program. Each survival number measures the percentage of
patients who have a functioning graft (Table 10) or who are alive (Table 11)
at 1 month, 1 year, and 3 years after transplant. |
The expected survival rate for a given program is the percentage of grafts
functioning (or patients alive) that would be expected for the patients
served by this program, given their characteristics (age, disease, blood
type, etc.) and the experience of similar patients in the entire country. At
this program, the expected one-year patient survival rate of 92.04 may be
different from the national average of 88.79 if patients transplanted at this
program have characteristics that would make us expect a different survival
rate than the average. |
At Loma Linda University Medical Center (CALL), 84.57 percent of adult
patients were alive one year after transplant, compared to the 92.04 percent
that would be expected based on the characteristics of these patients.
However, the p-value of 0.104 indicates that the difference between these
rates is not statistically significant. Similar comparisons may be made for
shorter- (1 month) and longer-term (3 year) survival, also in Table 11, as
well as for graft survival (Table 10). Further discussion of actual,
expected, and national survival rates may be found in the Table Details
section below. |
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