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USC tells of liver program changes

Hospital says it has altered how it chooses patients. New data show the survival rate, though improved, is still subpar.

January 12, 2007|Tracy Weber and Charles Ornstein | Times Staff Writers

USC University Hospital in Los Angeles said Thursday that it has changed the way it selects liver transplant patients, the same day a new report showed that its liver program continued to have one of the worst survival rates in the nation.

Just 77.3% of USC's liver transplant patients were still alive a year after surgery, according to national transplant statistics released Thursday. Based on the condition of its patients and organs, USC was expected to have a survival rate of 83.3%.

Though the difference may seem small, USC operates on dozens of patients each year, and the toll adds up over time.

In a statement, the hospital said officials are "acutely aware" of the program's low rating in the report, "and we are working diligently to correct any and all of the factors that put us there." Officials declined to provide specifics but acknowledged in a Times report last month that they were consciously taking high-risk patients.

USC was among 28 adult organ transplant programs nationwide that had more deaths than expected. The vast majority of those programs have previously been identified as subpar in national reports, which cover 2 1/2 -year stretches.

Most of the nation's hundreds of transplant programs have survival rates that fall within expected ranges. In California, USC is the only transplant program with an inferior rate.

This is the third consecutive time that USC has been flagged by the Scientific Registry of Transplant Recipients, the agency that analyzes transplant data on behalf of the federal government. The group releases an updated report every six months.

Of the 177 patients who received liver transplants at USC from July 2003 to December 2005, 38 died within a year of surgery. That's 12 more than expected. Though still subpar, USC's latest survival rate marks a slight improvement over its performance in the last report.

Transplant experts said the statistics deserve careful attention, not only from regulators and insurance companies, but from patients as well. A low survival rate may reflect an unusual or temporary problem, but centers with consistently poor records may have serious underlying issues.

"Without a doubt, it's a flag to the center that they've got a problem," said Dr. John Roberts, chief of UC San Francisco Medical Center's transplant service.

Dr. John R. Lake, director of liver transplants at the University of Minnesota Medical Center, said that if his program were identified even once for subpar performance, "it would be a reason for serious concern."

Besides the consequences for patients, he said, "insurers are using that exact data to determine whether you are going to be a so-called center of excellence. That isn't a small concern."

Some insurers will drop programs that they don't consider centers of excellence.

The Times first reported on USC's troubling survival rate in July. The hospital immediately hired outside experts to review its program. In a subsequent story last month, the paper quoted top transplant surgeons, who suggested that the liver program may have been choosing the wrong patients for transplants or using organs of poor quality.

USC suggested at the time that its patients were sicker than program statistics suggested, making expectations for its performance artificially high. The program was taking these high-risk patients to give them a shot at survival, officials said.

According to medical and internal records, USC was taking in patients with serious coexisting conditions -- bacterial infections, vascular disorders and extremely low blood pressure -- that experts say would have ruled out transplants at more conservative programs.

On Thursday, the hospital said the external review of its liver program is not yet complete "and we expect it to be ongoing for some time." In the meantime, the hospital said it has changed its patient selection criteria and reviewed the way it keeps track of patient information so their conditions are accurately reflected in transplant statistics.

The hospital has also dramatically cut back on the number of transplants it performed, from 92 in 2005 to 54 last year.

Because the national reports reflect 2 1/2 -year cycles, the hospital said it will take a while for its changes to significantly boost its patient survival rate.

USC's Keck School of Medicine, which runs the clinical aspects of the program, declined to comment for this article.

Late last month, because of concerns about USC's liver survival rate, the state Medi-Cal program placed the program on one-year provisional status -- akin to probation -- before deciding whether it will keep receiving state funds. Although the state continues to support USC's efforts, it wants to ensure that corrective measures are put in place, a state official said in a letter to Dr. Rick Selby, USC liver transplant director.

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