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Comparative Study
. 2012 Apr;12(4):947-53.
doi: 10.1111/j.1600-6143.2011.03962.x. Epub 2012 Feb 2.

Patient, center and geographic characteristics of nationally placed livers

J C Lai  1 , J P Roberts, E Vittinghoff, N A Terrault, S Feng
Affiliations
Comparative Study

Patient, center and geographic characteristics of nationally placed livers

J C Lai et al. Am J Transplant. 2012 Apr.

Abstract

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.

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Conflict of interest statement

Disclosure

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

Figure 1
Figure 1
Center distribution of nationally placed livers.
Figure 2
Figure 2
Unadjusted (A) patient and (B) graft survival curves by national versus local distribution.
See this image and copyright information in PMC

Comment in

References

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