The Aggressive Phenotype Revisited: Utilization of Higher‐Risk Liver Allografts. Issue 4 (15th February 2013)

• Record Type: Journal Article
• Authors: Garonzik‐Wang, J. M.; James, N. T.; Arendonk, K. J. Van; Gupta, N.; Orandi, B. J.; Hall, E. C.; Massie, A. B.; Montgomery, R. A.; Dagher, N. N.; Singer, A. L.; Cameron, A. M.; Segev, D. L.
• Is Part Of: American journal of transplantation. Volume 13:Issue 4(2013:Apr.)
• Page Start: 936
• Page End: 942
• Publication Date: 2013-02-15
• Subjects: Extended criteria donors -- graft acceptance -- liver transplantation -- transplant centers; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.12151
• Languages: English
• ISSNs: 1600-6135

Abstract

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. Abstract : This national study of center‐level utilization of various categories of livers suggests that high waitlist disease severity, organ availability, and transplant volume are the main drivers of aggressive utilization of higher‐risk livers. See editorial by Lai and Feng on page 837.