TY - JOUR
T1 - Offer acceptance practices and geographic variability in allocation model for end-stage liver disease at transplant
AU - Wey, Andrew
AU - Pyke, Joshua
AU - Schladt, David P.
AU - Gentry, Sommer E.
AU - Weaver, Tim
AU - Salkowski, Nicholas
AU - Kasiske, Bertram L.
AU - Israni, Ajay K.
AU - Snyder, Jon J.
N1 - Funding Information:
This work was conducted under the auspices of the Minneapolis Medical Research Foundation, contractor for the Scientific Registry of Transplant Recipients, as a deliverable under contract number HHSH2502015000 09C (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). As a US government–sponsored work, there are no restrictions on its use. The views expressed herein are those of the authors and not necessarily those of the US government. Ajay K. Israni was partially supported by R01 HS 24527. Sommer E. Gentry was partially supported by 1R01DK111233-01 from the National Institute of Diabetes and Digestive and Kidney Diseases.
Publisher Copyright:
© 2018 by the American Association for the Study of Liver Diseases.
PY - 2018/4
Y1 - 2018/4
N2 - Offer acceptance practices may cause geographic variability in allocation Model for End-Stage Liver Disease (aMELD) score at transplant and could magnify the effect of donor supply and demand on aMELD variability. To evaluate these issues, offer acceptance practices of liver transplant programs and donation service areas (DSAs) were estimated using offers of livers from donors recovered between January 1, 2016, and December 31, 2016. Offer acceptance practices were compared with liver yield, local placement of transplanted livers, donor supply and demand, and aMELD at transplant. Offer acceptance was associated with liver yield (odds ratio, 1.32; P < 0.001), local placement of transplanted livers (odds ratio, 1.34; P < 0.001), and aMELD at transplant (average aMELD difference, –1.62; P < 0.001). However, the ratio of donated livers to listed candidates in a DSA (ie, donor-to-candidate ratio) was associated with median aMELD at transplant (r = −0.45; P < 0.001), but not with offer acceptance (r = 0.09; P = 0.50). Additionally, the association between DSA-level donor-to-candidate ratios and aMELD at transplant did not change after adjustment for offer acceptance. The average squared difference in median aMELD at transplant across DSAs was 24.6; removing the effect of donor-to-candidate ratios reduced the average squared differences more than removing the effect of program-level offer acceptance (33% and 15% reduction, respectively). Offer acceptance practices and donor-to-candidate ratios independently contributed to geographic variability in aMELD at transplant. Thus, neither offer acceptance nor donor-to-candidate ratios can explain all of the geographic variability in aMELD at transplant. Liver Transplantation 24 478–487 2018 AASLD.
AB - Offer acceptance practices may cause geographic variability in allocation Model for End-Stage Liver Disease (aMELD) score at transplant and could magnify the effect of donor supply and demand on aMELD variability. To evaluate these issues, offer acceptance practices of liver transplant programs and donation service areas (DSAs) were estimated using offers of livers from donors recovered between January 1, 2016, and December 31, 2016. Offer acceptance practices were compared with liver yield, local placement of transplanted livers, donor supply and demand, and aMELD at transplant. Offer acceptance was associated with liver yield (odds ratio, 1.32; P < 0.001), local placement of transplanted livers (odds ratio, 1.34; P < 0.001), and aMELD at transplant (average aMELD difference, –1.62; P < 0.001). However, the ratio of donated livers to listed candidates in a DSA (ie, donor-to-candidate ratio) was associated with median aMELD at transplant (r = −0.45; P < 0.001), but not with offer acceptance (r = 0.09; P = 0.50). Additionally, the association between DSA-level donor-to-candidate ratios and aMELD at transplant did not change after adjustment for offer acceptance. The average squared difference in median aMELD at transplant across DSAs was 24.6; removing the effect of donor-to-candidate ratios reduced the average squared differences more than removing the effect of program-level offer acceptance (33% and 15% reduction, respectively). Offer acceptance practices and donor-to-candidate ratios independently contributed to geographic variability in aMELD at transplant. Thus, neither offer acceptance nor donor-to-candidate ratios can explain all of the geographic variability in aMELD at transplant. Liver Transplantation 24 478–487 2018 AASLD.
UR - http://www.scopus.com/inward/record.url?scp=85044447955&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044447955&partnerID=8YFLogxK
U2 - 10.1002/lt.25010
DO - 10.1002/lt.25010
M3 - Article
C2 - 29316203
AN - SCOPUS:85044447955
SN - 1527-6465
VL - 24
SP - 478
EP - 487
JO - Liver Transplantation
JF - Liver Transplantation
IS - 4
ER -