Differences in access to liver tx: severity, time, & center volume.

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Ann Intern Med. 2007 May 15.

Differences

in access to liver transplantation: disease severity, waiting time, and

transplantation center volume.

Ahmad J, Bryce CL, Cacciarelli T, MS.

Veterans Affairs

Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh,

Pennsylvania

BACKGROUND: The Model for End-Stage Liver Disease (MELD) score has been used

since February 2002 to allocate livers for transplantation from deceased donors

according to medical need. Allocation based on MELD

scores should ensure that sicker patients receive transplants first regardless

of transplantation center volume.

OBJECTIVE: To

determine whether the MELD score at transplantation and waiting time of liver

transplant recipients differs by transplantation center volume.

DESIGN: Analysis

of the Organ Procurement and Transplantation Network database.

Centers were classified according to the volume of transplantations

performed in 2005: high (> or =100 transplantations), medium (50 to 99

transplantations), and low (<50 transplantations).

SETTING:

Transplantation centers in the United States.

PATIENTS: 20,075

transplant recipients between 27 February 2002 and 30 April 2006.

MEASUREMENTS:

MELD scores and waiting times of liver transplant recipients.

RESULTS:

Transplant recipients at high-volume centers had lower MELD scores (35.1% with

MELD scores < or =18 vs. 22.7% and 27.0% at medium- and low-volume centers,

respectively; P < 0.001), and the median MELD score was 22 compared with 24

at both medium- and low-volume centers. Despite having

lower MELD scores, recipients at high-volume centers also experienced shorter waiting

times (median waiting time, 69 days vs. 98 days and 94 days at medium-and

low-volume centers, respectively; P < 0.001).

LIMITATIONS: The

definition of transplantation center volume was subjective. The

recent implementation of MELD precluded analysis of differences in long-term

outcomes related to waiting time or center volume.

CONCLUSIONS: The

MELD scores and waiting time of liver transplant recipients differed by

transplantation center volume. High-volume centers

have shorter waiting times and perform more transplantations for less sick

patients. The reasons for these differences are

unclear but warrant further investigation. PMID:

17502631 [PubMed - in process]

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