S. I. Canizares1, A. Montalvan1, D. Lee1, D. Eckhoff1 1Beth Israel Deaconess Medical Center, Transplant Institute, Boston, MA, USA
Introduction:
An imbalance in the supply and demand of organs persists in transplantation. The development of methods for preservation and reconditioning of previously discarded grafts opened the possibility to extend their utilization. However, the implementation of machine perfusion (MP) in clinical practice has not been widely adopted throughout the country. We explored trends of MP adoption in the United States and their effect on individual center volume.
Methods:
We analyzed center volume and MP experience of the top 20 high-volume centers identified in 2015 before clinical trials (CT) and after FDA approval in 2022 using the UNOS Standard Transplant Analysis and Research (STAR) file. The cutoff date was defined in the fall of 2021 when the FDA granted approval. Centers were classified into MP users or non-users. Among users, we identified whether they participated in CT or started using MP after the cutoff date. User centers were also categorized as high MP use (HMP) if they fall in the 75th percentile by 2023. Center volume was calculated by the number of cases from each center over the total number of transplants performed within a year. We performed a two sample proportion test to compare center volume in 2015 and 2022 within each center and an interrupted time series (ITS) analysis to assess the effect of the initiation of clinical trials in 2016 on center volume growth among HMP centers.
Results:
Among the top 20 high-volume institutions in 2015, we found that 10% had not used MP until 2023, 75% participated in CT and only 50% continued using MP after FDA approval. 15% started using MP after the cutoff date and one of them reached a HMP category by 2023. We observed a significant decrease in volume in centers that did not undertake MP and in those that participated in CT but did not continue using MP after the cutoff date. Among the remaining centers that continued using MP, a significant increase in volume was observed in most but not all institutions. In the ITS, we found a sustained increase in volume in HMP centers after the initiation of CT in 2016 (p = 0.002).
Conclusion:
Previously MP has been demonstrated to greatly improve outcomes for recipients of liver transplantation. Herein, we demonstrate that centers that incorporated MP have also experienced an added benefit of significant growth in their practice as well. The heterogeneity among high-volume centers in 2015 suggests that key baseline factors independent of center volume may influence their current behavior. Further studies are needed to analyze centers' behavior determinants and better characterize the features that drive transplant centers to take most advantage of this technology.
