USC Center Is Latest With Transplant Woes
The liver transplant program at USC University Hospital in Los Angeles has one of the highest death rates in the nation, with twice as many patients as expected dying after their surgeries, according to data released this week.
The most recent statistics show that 38 USC patients who received new livers from January 2003 to June 2005 died within a year of surgery -- 19 more than expected, according to the Scientific Registry of Transplant Recipients. The agency, which analyzes data on behalf of the federal government, determines the expected rate for each center after adjusting for such factors as patient age and condition and organ quality.
The troubles at USC follow scandals that forced the closure of two other liver transplant programs in Southern California last year: at St. Vincent and UCI medical centers. But USC’s reach is far greater: It performed 92 transplants last year, about three times as many as St. Vincent and UCI combined did in any recent year.
A review by The Times shows that the one-year survival rate at USC’s liver transplant center, the third-largest in the state, steadily dropped since at least 2002, hitting a low of 75.8% in the new report. That is far below the U.S. average of 86.6%.
Just four adult centers nationally had lower survival rates over the same period.
USC’s rate also falls below federal and state standards to receive certification and funding from government programs. The Medicare program requires a raw survival rate of 77%, and the Medi-Cal program demands 80%.
Dr. Rick Selby, director of USC’s liver transplant program, said patients should not be alarmed by its survival rate.
“It’s clearly not because we don’t know what we’re doing,” he said, noting that the transplant team has remained virtually unchanged in recent years. In fact, for a period, USC’s survival rate was above the national average.
“We know what we’re doing,” he said. “We don’t want to be painted with a broader brushstroke as an incompetent program.”
The California Department of Health Services said Wednesday that it found the newly released statistics “a concern” and will begin investigating. Meanwhile, the U.S. Centers for Medicare and Medicaid Services, already under fire as lax in oversight of transplant programs, is conducting a broad review of all federally funded centers.
After learning of USC’s numbers from The Times, Cheryl Rader questioned the treatment her husband, John, received there.
He received a new liver at USC in June 2005. The transplant was a chance to regain a life derailed by a progressive liver disease -- but John, 64, died 3 1/2 months later of a post-transplant infection.
“He shouldn’t have died,” his widow said. “It was a tragedy that he died. It shouldn’t have happened.”
Selby offered various explanations for the program’s record -- including a very sick patient pool -- but studies and transplant experts indicate that the reasons offered cannot account for the results.
Dr. John R. Lake, director of liver transplants at the University of Minnesota Medical Center, said the expected survival rate for each hospital takes into account the severity of illness. He also said that with the large number of transplants performed by USC, the results cannot be attributed to chance.
“You have twice as many deaths as expected,” he said. “It’s pretty hard to chalk that up to bad luck.”
Lake chairs the liver and intestinal organ transplantation committee of the United Network for Organ Sharing, the federal contractor responsible for the safety and equity of the national transplant system.
He and other experts expect the group to immediately demand answers from USC and visit the private hospital in Boyle Heights to investigate.
Dr. Goran Klintmalm, head of the Baylor Regional Transplant Institute in Dallas, said the two top liver surgeons at USC are “very good guys. They know the business.”
But “when this happens, what comes to my mind is essentially a question of what the hell is going on?” he said. Outside scrutiny of the numbers “would force the institution to get in line and get their act together.”
The troubles at USC University Hospital, owned by the for-profit Tenet Healthcare Corp., only adds to concerns about the performance and oversight of liver centers in the Southland.
St. Vincent in Los Angeles halted its liver program in September after officials admitted that in 2003 its doctors improperly arranged a transplant for one patient using an organ intended for another, higher-priority St. Vincent patient. Staff then falsified records to cover up the situation, officials have said.
UCI in Orange shut down its liver program in November after The Times reported that 32 people awaiting livers died in 2004 and 2005 while the hospital turned down viable organs that might have saved some of them. For more than a year, the hospital had no full-time liver transplant surgeon.
John Rader and others had initially been on the liver transplant waiting list at UCI but were referred to USC by doctors.
Just four adult liver transplant centers, including USC’s, are now operating in the region, which covers all of Southern California except for San Diego and Imperial counties.
Although poor survival rates are often the bane of smaller, less-experienced centers, USC is not alone among medium-to-large programs in facing troubles.
The most recent statistics show that Johns Hopkins Hospital in Baltimore, for example, had a survival rate of 76% and that St. Louis University Hospital’s was 78.8%, both with nearly twice the number of deaths as expected.
USC’s Selby offered two main explanations over the last two days for the low survival rate. First, he theorized that the numbers suffered because of the way the program handles liver patients who are also on kidney dialysis. Selby said other centers routinely perform combined liver-kidney transplants for these patients, who are often very sick. By contrast, USC doctors believe that most of these patients are better served by receiving only liver transplants because they say the kidneys often recover on their own afterward.
Statistics for kidney-liver transplants and liver-only transplants are tracked separately by government contractors.
Selby said he thinks the other centers’ survival rates would be lower -- and comparable to his program’s -- if the patients who underwent combined transplants were included with the liver-only statistics. He said he had no data to support his hypothesis, but “that’s the best explanation I can come up with.”
“Maybe I’m wrong, and I need to adjust my own practice,” he said. “I don’t think so. I’ll be surprised.”
Research and statistics reviewed by The Times, however, show that Selby’s premise appears to be inaccurate.
A presentation given at a transplant conference last year indicated that UCLA Medical Center’s one-year survival rate for the 28 patients who had kidney-liver transplants from March 2002 to August 2004 was 86%. UCLA’s liver-only patients survived at about the same rate.
Data from the Scientific Registry of Transplant Recipients also showed that in 2003, the most recent year for which statistics are available, patients who underwent kidney-liver transplants had an average survival rate of 81%, still higher than USC’s latest survival rate for livers only.
Responding to this information, Selby offered another reason for the poor rate: the high number of extremely ill patients overall who receive transplants at USC.
“For us, the decision is: Do we continue to do patients that are that sick?” he said. “That’s the bottom line. I think it’s a mistake to run away from them.”
If USC is forced to focus solely on survival statistics, he said, “the overall result of that policy will be to drive down the overall number of transplants” and cause some people to die waiting.
But at least one local center that treated a much higher proportion of very sick patients than USC had far better outcomes, according to the latest statistics: Loma Linda University Medical Center’s program had a survival rate of 98%.
Some USC liver patients say they have been led to believe that the program is among the best.
When Steven Stone, 55, joined the waiting list in March, he said, a social worker leading an orientation boasted about the program’s outcomes. “They made it sound like it was one of the top,” said Stone, of Duarte, who suffers from hepatitis C . “I said, ‘It sounds good to me.’ ”
He wants to leave USC’s program, not because of its survival rate, but to go to another region where the waiting time for a liver is not so long.
If he leaves, the hospital will still have 318 other patients on its waiting list.
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Times staff writer Alan Zarembo contributed to this report.
Tracy Weber can be reached at tracy.weber@latimes.com
and Charles Ornstein at
charles.ornstein@latimes.com.
