title: Differences in access to liver transplantation: disease severity, waiting time, and transplantation center volume.
abstract: BACKGROUND
  The Model for End-Stage Liver Disease (MELD) score has been used since February 2002 to allocate livers for transplantation from deceased donors according to medical need. Allocation based on MELD scores should ensure that sicker patients receive transplants first regardless of transplantation center volume.
  
  
  OBJECTIVE
  To determine whether the MELD score at transplantation and waiting time of liver transplant recipients differs by transplantation center volume.
  
  
  METHODS
  Analysis of the Organ Procurement and Transplantation Network database. Centers were classified according to the volume of transplantations performed in 2005: high (> or =100 transplantations), medium (50 to 99 transplantations), and low (<50 transplantations).
  
  
  METHODS
  Transplantation centers in the United States.
  
  
  METHODS
  20 075 transplant recipients between 27 February 2002 and 30 April 2006.
  
  
  METHODS
  MELD scores and waiting times of liver transplant recipients.
  
  
  RESULTS
  Transplant recipients at high-volume centers had lower MELD scores (35.1% with MELD scores < or =18 vs. 22.7% and 27.0% at medium- and low-volume centers, respectively; P < 0.001), and the median MELD score was 22 compared with 24 at both medium- and low-volume centers. Despite having lower MELD scores, recipients at high-volume centers also experienced shorter waiting times (median waiting time, 69 days vs. 98 days and 94 days at medium-and low-volume centers, respectively; P < 0.001).
  
  
  CONCLUSIONS
  The definition of transplantation center volume was subjective. The recent implementation of MELD precluded analysis of differences in long-term outcomes related to waiting time or center volume.
  
  
  CONCLUSIONS
  The MELD scores and waiting time of liver transplant recipients differed by transplantation center volume. High-volume centers have shorter waiting times and perform more transplantations for less sick patients. The reasons for these differences are unclear but warrant further investigation.
authors.affiliation: Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA. ahmadj@msx.upmc.edu
authors.forename: Jawad
authors.initials: J
authors.lastname: Ahmad
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Bryce
authors.forename: Thomas
authors.initials: T
authors.lastname: Cacciarelli
authors.forename: Mark S
authors.initials: MS
authors.lastname: Roberts
mesh_terms: D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D017093:Liver Failure / Q000601:surgery; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors; D014481:United States; D014850:Waiting Lists