Regional differences in deceased donor liver transplantation and their implications for organ utilization and allocation.
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.
Liver Program, University of North Carolina, Chapel Hill, NC 27599-7584, USA. paul_hayashi@med.unc.edu
Paul H
PH
Hayashi
David A
DA
Axelrod
Joseph
J
Galanko
Paolo R
PR
Salvalaggio
Mark
M
Schnitzler
D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D002648:Child; D005260:Female; D005843:Geography; D006085:Graft Survival; D006752:Hospital Planning / Q000706:statistics & numerical data*; D006801:Humans; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement; D055815:Young Adult