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Regional differences in deceased donor liver transplantation and their implications for organ utilization and allocation.

Abstract：

:We examined the UNOS database from 7/15/00-7/17/05 for Regional deceased donor liver utilization. For each region, we performed logistic regression and derived odds ratios (OR) for donor characteristics associated with livers being transplanted outside of the region or not transplanted at all. Regions with smallest and least significant OR were considered aggressive users of suboptimal organs. We estimated how many untransplanted livers from less aggressive regions might be used by more aggressive regions. Only Region 9 was significantly more aggressive than others (median OR: 6 vs. 16; p < 0.01; median OR size: 1.4 vs. 3.6; p < 0.01). Region 9 transplanted at higher median Model for End-stage Liver Disease (MELD) score (20.4 [6-73] vs. 18.3 [6-70], p < 0.01), but had the lowest one- and five-yr graft survival (p < 0.01). Of 30,474 livers, 5056 were not transplanted, of which 3690 were procured outside Region 9 but met Region 9 use criteria. Of these, 1488 and 1807 livers had donor risk indices ≤ 2, for hypothetical 12 and 8 h cold ischemia time (CIT), respectively. Regional differences in liver utilization are profound. Region 9 is significantly more aggressive. At the most, 297-361 organs per year may have been used under Region 9's use criteria but overall graft survival may have declined.

journal_name

Clin Transplant

journal_title

Clinical transplantation

authors

Hayashi PH,Axelrod DA,Galanko J,Salvalaggio PR,Schnitzler M

doi

10.1111/j.1399-0012.2010.01214.x

subject

Has Abstract

pub_date

2011-01-01 00:00:00

pages

156-63

issue

1

eissn

0902-0063

issn

1399-0012

pii

CTR1214

journal_volume

25

pub_type

杂志文章

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