title: Hospital Utilization of Nationally Shared Liver Allografts from 2007 to 2012.
abstract: BACKGROUND
  Due to the current geographic disparities in liver allocation a policy, which endorses broader sharing of allografts, has been proposed. We performed a retrospective cohort study to identify how nationally shared allografts, under the current policy, affect perioperative outcomes and resource utilization following liver transplantation (LT).
  
  
  METHODS
  Univariate and multivariate analysis identified how patient characteristics and hospital outcomes were associated with national sharing. This analysis was based on 12,282 deceased donor liver transplants performed between 2007 and 2012 using the scientific registry of transplant recipients linked to the University HealthSystem Consortium database.
  
  
  RESULTS
  Compared to locally distributed livers, nationally shared livers are more likely to have a donor risk index >1.8 (64.3 vs. 11.6 %), to be classified as expanded criteria donors (44.6 vs. 24.8 %), and transplanted into healthier recipients. Nationally shared LTs were more likely to be performed at high-volume centers (49.1 vs. 30.6 %), resulted in longer length of stay (11 vs. 9 days), and had higher in-hospital mortality (6.6 vs. 3.3 %). Additionally, nationally shared allografts were independent predictors of in-hospital mortality (OR 1.64, 95 % CI 1.13-2.39) and length of stay (OR 1.12, 95 % CI 1.02-1.21).
  
  
  CONCLUSIONS
  These data suggest that increased national sharing of livers may result in inferior patient outcomes and increased resource utilization.
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267-0558, USA.
authors.forename: Audrey E
authors.initials: AE
authors.lastname: Ertel
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267-0558, USA.
authors.forename: Koffi
authors.initials: K
authors.lastname: Wima
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267-0558, USA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Hoehn
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267-0558, USA.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Abbott
authors.affiliation: Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267-0558, USA. shimul.shah@uc.edu.|Division of Transplant Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way, ML 0558, MSB 2006C, Cincinnati, OH, 45267-0558, USA. shimul.shah@uc.edu.
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
mesh_terms: D000328:Adult; D064591:Allografts; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016031:Liver Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D066027:Transplant Recipients / Q000706:statistics & numerical data*