Differences in access to liver tx /disease, time, & center volume.

[Guest guest]

Ann Intern Med. 2007 May 15;146(10):707-13.

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

15213, USA.

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

- indexed for MEDLINE]

Barb in Texas - Together in the Fight, Whatever it Takes!

Son Ken (33) UC 91 - PSC 99 Listed 7/21/06 @ Baylor Dallas