Patient deaths, liver transplant failures spiked over 2 years at UC San Diego

An oversight report revealed the liver transplant program at UC San Diego Health Jacobs Medical Center showed more patient deaths and transplant failures than expected — but administrators say the spike is temporary, The San Diego Union-Tribune reports.

Eight things to know:

1. The hospital's treatment of numerous high-risk patients in 2016 caused the increase in patient deaths and failures, but results returned to expected levels in 2017 and 2018, hospital leadership said in a statement obtained by the Union-Tribune. The 2017 and 2018 results have yet to be publicly reported.

2. The report, released by the Scientific Registry of Transplant Recipients in January, came less than two months after the university appointed a new liver transplant program director. The university replaced Alan Hemming, MD, with Kristin Mekeel, MD.

3. Dr. Hemming is still a member of the university's medical school faculty but is not treating patients at any of its facilities, UC San Diego officials confirmed to the Union-Tribune. Administrators did not say whether there was a link between the registry report and the program's recent leadership changes.

4. From July 1, 2014 to Dec. 31, 2016, UC San Diego liver transplant patients experienced 13 graft failures and 7 deaths in their first year after surgery, according to the report.

After taking overall sickness of both recipient and donor into account, statistical modeling estimated about seven graft failures and five deaths would be expected for the 77 liver transplant patients the program saw during the 2½-year period.

5. Although the gap between expected and observed graft failures is not wide enough to be statistically significant, the 13 failures seem to be toward the high end of the registry's range of expectations, the Union-Tribune reported.

The disparity between observed and expected rates of graft failure and patient deaths has widened compared to the program's last report, released in July.

6. In 2016, the program had a combined total of eight graft failures or patient deaths in that single year, according to a statement from university administration. But the two statistics are not mutually exclusive, administrators said.

Since a graft failure sometimes causes a patient to die, and in other cases patients can receive a re-transplant operation, a patient can be counted as a graft failure and a death in registry statistics.

7. University administrators said they believe those poor results — between zero to two graft failures and/or patient deaths are expected each year in a program of UC San Diego's size — are attributed to the poor health of numerous patients who received transplants in 2016.

8. University administrators said the program's graft failure and death rate have improved since 2016. Two program patients died after graft failure in 2017; one in February; another in September; and none have died or suffered graft failure in 2018, administrators said.

The university and Dr. Hemming said the program is completing more quality reviews of "all graft losses and deaths within one year of transplant" and has identified and implemented improvements.

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