title: The aggressive phenotype revisited: utilization of higher-risk liver allografts.
abstract: 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.
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: J M
authors: JM
authors: Garonzik-Wang
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: N T
authors: NT
authors: James
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: K J Van
authors: KJV
authors: Arendonk
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: N
authors: N
authors: Gupta
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: B J
authors: BJ
authors: Orandi
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Department of Surgery, Georgetown University, Washington, DC, USA.
authors: E C
authors: EC
authors: Hall
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: A B
authors: AB
authors: Massie
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: R A
authors: RA
authors: Montgomery
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: N N
authors: NN
authors: Dagher
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: A L
authors: AL
authors: Singer
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors: A M
authors: AM
authors: Cameron
authors: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.|Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
authors: D L
authors: DL
authors: Segev
mesh_terms: D000328:Adult; D000368:Aged; D016000:Cluster Analysis; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000379:methods*; D008875:Middle Aged; D010641:Phenotype; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014184:Transplantation, Homologous; D019737:Transplants / Q000600:supply & distribution*