Patient, center and geographic characteristics of nationally placed livers.
Once a liver offer has been refused locally and regionally, it is offered nationally. We characterized nationally (n = 1567) versus locally (n = 19 893) placed grafts from adult, nonfulminant, deceased donor liver transplants (LT) from 2/1/05 to 1/31/10. Donors of nationally versus locally placed livers differed by age (50 vs. 42 years), positive HCV antibody (11 vs. 2%) and death from stroke (51 vs. 42%) (p < 0.001 for all). Recipients of nationally versus locally placed livers differed by LT-MELD (20 vs. 24), rates of ascites (35 vs. 37%), encephalopathy (12 vs. 15%), hepatocellular (17 vs. 24%) and nonhepatocellular exceptions (6 vs. 11%) (p ≤ 0.03 for all). Six (5%) centers utilized 64% of the nationally placed grafts while 43 (38%) centers accepted zero during the 5-year period; all high volume centers used ≥1. Compared to local distribution, transplantation with a nationally placed liver was associated with a similar adjusted risk of graft (HR, 0.99; 95% CI, 0.86-1.14) and patient (HR, 0.98; 95% CI, 0.84-1.14; p = 0.77) survival. In conclusion, utilization of nationally placed livers is highly concentrated in very few centers, with no increased adjusted risk of graft loss. These findings provide the foundation for a more informed discussion about changing our current liver allocation and distribution policies.
Department of Medicine, Division of Gastroenterology and Hepatology, University of California-San Francisco, San Francisco, CA, USA.
J C
JC
Lai
J P
JP
Roberts
E
E
Vittinghoff
N A
NA
Terrault
S
S
Feng
D000328:Adult; D046148:Donor Selection; D058625:End Stage Liver Disease / Q000453:epidemiology* / Q000628:therapy; D005006:Ethnicity; D005260:Female; D006085:Graft Survival; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement; D014481:United States / Q000453:epidemiology