期刊
AMERICAN JOURNAL OF TRANSPLANTATION
卷 22, 期 7, 页码 1901-1908出版社
ELSEVIER SCIENCE INC
DOI: 10.1111/ajt.17006
关键词
donor risk; donor risk index; donor utilization; geographic disparities; liver allocation; liver allocation policy; liver redistribution; liver redistricting; marginal donors; median MELD at transplant; MMaT; non-ideal donors
资金
- Ohio State University Center for Clinical and Translational Science [UL1TR00273]
The liver allocation policy was changed in February 2020 to reduce variability in median MELD scores at transplant. The impact of this policy change on donor utilization is crucial. Centers implemented various strategies to broaden organ acceptance criteria and increase transplant volume.
Liver allocation policy was changed to reduce variance in median MELD scores at transplant (MMaT) in February 2020. Acuity circles replaced local allocation. Understanding the impact of policy change on donor utilization is important. Ideal (I), standard (S), and non-ideal (NI) donors were defined. NI donors include older, higher BMI donors with elevated transaminases or bilirubin, history of hepatitis B or C, and all DCD donors. Utilization of I, S, and NI donors was established before and after allocation change and compared between low MELD (LM) centers (MMaT <= 28 before allocation change) and high MELD (HM) centers (MMaT > 28). Following reallocation, transplant volume increased nationally (67 transplants/center/year pre, 74 post, p .0006) and increased for both HM and LM centers. LM centers significantly increased use of NI donors and HM centers significantly increased use of I and S donors. Centers further stratify based on donor utilization phenotype. A subset of centers increased transplant volume despite rising MMaT by broadening organ acceptance criteria, increasing use of all donor types including DCD donors (98% increase), increasing living donation, and transplanting more frequently for alcohol associated liver disease. Variance in donor utilization can undermine intended effects of allocation policy change.
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