TY - JOUR
T1 - The aggressive phenotype revisited
T2 - Utilization of higher-risk liver allografts
AU - Garonzik-Wang, J. M.
AU - James, N. T.
AU - Arendonk, K. J.Van
AU - Gupta, N.
AU - Orandi, B. J.
AU - Hall, E. C.
AU - Massie, A. B.
AU - Montgomery, R. A.
AU - Dagher, N. N.
AU - Singer, A. L.
AU - Cameron, A. M.
AU - Segev, D. L.
PY - 2013/4
Y1 - 2013/4
N2 - Organ shortage has led to increased utilization of higher risk liver allografts. In kidneys, aggressive center-level use of one type of higher risk graft clustered with aggressive use of other types. In this study, we explored center-level behavior in liver utilization. We aggregated national liver transplant recipient data between 2005 and 2009 to the center-level, assigning each center an aggressiveness score based on relative utilization of higher risk livers. Aggressive centers had significantly more patients reaching high MELDs (RR 2.19, 2.33 and 2.28 for number of patients reaching MELD > 20, MELD > 25 and MELD > 30, p < 0.001), a higher organ shortage ratio (RR 1.51, 1.60 and 1.51 for number of patients reaching MELD > 20, MELD > 25 and MELD > 30 divided by number of organs recovered at the OPO, p < 0.04), and were clustered within various geographic regions, particularly regions 2, 3 and 9. Median MELD at transplant was similar between aggressive and nonaggressive centers, but average annual transplant volume was significantly higher at aggressive centers (RR 2.27, 95% CI 1.47-3.51, p < 0.001). In cluster analysis, there were no obvious phenotypic patterns among centers with intermediate levels of aggressiveness. In conclusion, highwaitlist disease severity, geographic differences in organ availability, and transplant volume are the main factors associated with the aggressive utilization of higher risk livers.
AB - Organ shortage has led to increased utilization of higher risk liver allografts. In kidneys, aggressive center-level use of one type of higher risk graft clustered with aggressive use of other types. In this study, we explored center-level behavior in liver utilization. We aggregated national liver transplant recipient data between 2005 and 2009 to the center-level, assigning each center an aggressiveness score based on relative utilization of higher risk livers. Aggressive centers had significantly more patients reaching high MELDs (RR 2.19, 2.33 and 2.28 for number of patients reaching MELD > 20, MELD > 25 and MELD > 30, p < 0.001), a higher organ shortage ratio (RR 1.51, 1.60 and 1.51 for number of patients reaching MELD > 20, MELD > 25 and MELD > 30 divided by number of organs recovered at the OPO, p < 0.04), and were clustered within various geographic regions, particularly regions 2, 3 and 9. Median MELD at transplant was similar between aggressive and nonaggressive centers, but average annual transplant volume was significantly higher at aggressive centers (RR 2.27, 95% CI 1.47-3.51, p < 0.001). In cluster analysis, there were no obvious phenotypic patterns among centers with intermediate levels of aggressiveness. In conclusion, highwaitlist disease severity, geographic differences in organ availability, and transplant volume are the main factors associated with the aggressive utilization of higher risk livers.
KW - Extended criteria donors
KW - graft acceptance
KW - liver transplantation
KW - transplant centers
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U2 - 10.1111/ajt.12151
DO - 10.1111/ajt.12151
M3 - Article
C2 - 23414232
AN - SCOPUS:84875838857
SN - 1600-6135
VL - 13
SP - 936
EP - 942
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 4
ER -