Top

World Journal of Surgery

Published in:

01-04-2016 | Original Scientific Report

Hospital Utilization of Nationally Shared Liver Allografts from 2007 to 2012

Authors: Audrey E. Ertel, Koffi Wima, Richard S. Hoehn, Daniel E. Abbott, Shimul A. Shah

Published in: World Journal of Surgery | Issue 4/2016

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).

Conclusion

These data suggest that increased national sharing of livers may result in inferior patient outcomes and increased resource utilization.

Freeman RB, Wiesner RH, Edwards E et al (2004) Results of the first year of the new liver allocation plan. Liver Transpl 10(1):7–15CrossRefPubMed

Washburn K, Harper A, Klintmalm G et al (2006) Regional sharing for adult status 1 candidates: reduction in waitlist mortality. Liver Transpl 12(3):470–474CrossRefPubMed

Washburn K, Pomfret E, Roberts J (2011) Liver allocation and distribution: possible next steps. Liver Transpl 17(9):1005–1012PubMed

Yeh H, Smoot E, Schoenfeld DA et al (2011) Geographic inequity in access to livers for transplantation. Transplantation 91(4):479–486PubMedCentralPubMed

Rana A, Kaplan B, Riaz IB et al (2015) Geographic inequities in liver allograft supply and demand: does it affect patient outcomes? Transplantation 99(3):515–520CrossRefPubMed

Roberts JP, Dykstra DM, Goodrich NP et al (2006) Geographic differences in event rates by model for end-stage liver disease score. Am J Transplant 6(10):2470–2475CrossRefPubMed

Organ Procurement and Transplantation Network (2015) Concept document: Redesigning liver distribution to reduce variation in access to liver transplantation. http://optn.transplant.hrsa.gov/ContentDocuments/Liver_Concepts_2014.pdf. Accessed February 2015

Shaw JJ, Santry HP, Shah SA (2013) Specialization and utilization after hepatectomy in academic medical centers. J Surg Res 185(1):433–440PubMedCentralCrossRefPubMed

Macomber CW, Shaw JJ, Santry H et al (2012) Centre volume and resource consumption in liver transplantation. HPB (Oxford) 14(8):554–559CrossRef

10.

Sutton JM, Hayes AJ, Wilson GC et al (2014) Validation of the University HealthSystem Consortium administrative dataset: concordance and discordance with patient-level institutional data. J Surg Res 190(2):484–490CrossRefPubMed

11.

Salvalaggio PR, Dzebisashvili N, MacLeod KE et al (2011) The interaction among donor characteristics, severity of liver disease, and the cost of liver transplantation. Liver Transpl 17(3):233–242PubMedCentralCrossRefPubMed

12.

Quillin RC 3rd, Wilson GC, Wima K et al (2014) Neighborhood level effects of socioeconomic status on liver transplant selection and recipient survival. Clin Gastroenterol Hepatol 12:1934–1941CrossRefPubMed

13.

Wilson GC, Quillin RC 3rd, Wima K et al (2014) Is liver transplantation safe and effective in elderly (≥70 years) recipients? A case-controlled analysis. HPB 16:1088–1094PubMedCentralCrossRefPubMed

14.

Kamath PS, Wiesner RH, Malinchoc M et al (2001) A model to predict survival in patients with end-stage liver disease. Hepatology 33(2):464–470CrossRefPubMed

15.

Feng S, Goodrich NP, Bragg-Gresham JL et al (2006) Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant 6(4):783–790CrossRefPubMed

16.

Akkina SK, Asrani SK, Peng Y et al (2012) Development of organ-specific donor risk indices. Liver Transpl 18(4):395–404PubMedCentralCrossRefPubMed

17.

Birkmeyer JD, Siewers AE, Finlayson EV et al (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346(15):1128–1137CrossRefPubMed

18.

Singla A, Simons J, Li Y et al (2009) Admission volume determines outcome for patients with acute pancreatitis. Gastroenterology 137(6):1995–2001CrossRefPubMed

19.

Lai JC, Roberts JP, Vittinghoff E et al (2012) Patient, center and geographic characteristics of nationally placed livers. Am J Transplant 12(4):947–953PubMedCentralCrossRefPubMed

20.

Axelrod DA, Gheorghian A, Schnitzler MA et al (2011) The economic implications of broader sharing of liver allografts. Am J Transplant 11(4):798–807CrossRefPubMed

Title: Hospital Utilization of Nationally Shared Liver Allografts from 2007 to 2012
Authors: Audrey E. Ertel
Koffi Wima
Richard S. Hoehn
Daniel E. Abbott
Shimul A. Shah
Publication date: 01-04-2016
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 4/2016
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-015-3357-1

At a glance: The STEP trials

Springer Medicine

Hospital Utilization of Nationally Shared Liver Allografts from 2007 to 2012

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2016

The Sternocleidomastoid Muscle Flap: A Versatile Local Method for Repair of External Penetrating Injuries of Hypopharyngeal–Cervical Esophageal Funnel

Cholecystectomy During the Weekend Increases Patients’ Length of Hospital Stay

High Rate of Organ/Space Surgical Site Infection After Hepatectomy with Preexisting Bilioenteric Anastomosis

Prediction of Lateral Pelvic Lymph-Node Metastasis in Low Rectal Cancer by Magnetic Resonance Imaging

Upregulation of Neutrophil Gelatinase-Associated Lipocalin in Colorectal Cancer Predicts Poor Patient Survival: Reply

Posthepatectomy Liver Failure Affects Long-Term Function After Resection for Hepatocellular Carcinoma