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Differences in Access to Liver Transplantation: Disease Severity, Waiting Time, and Transplantation Center Volume

Jawad Ahmad, MD; Cindy L. Bryce, PhD; Thomas Cacciarelli, MD; and Mark S. Roberts, MD, MPP
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From the Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania.

Disclaimer: The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the U.S. Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government.

Acknowledgments: The authors thank Chung-Chou H. Chang, PhD, for guidance with the statistical methods and Maxwell Farrell, BS, for completing the bootstrapping programs.

Grant Support: In part by the Health Resources and Services Administration (contract 231-00-0115). Dr. Bryce is supported by the National Institute for Diabetes and Digestive and Kidney Diseases (5K25 DK-002903-05).

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Jawad Ahmad, MD, Division of Gastroenterology and Hepatology, University of Pittsburgh, 3471 Fifth Avenue, Suite 916, Pittsburgh, PA 15213; e-mail, ahmadj@msx.upmc.edu.

Current Author Addresses: Dr. Ahmad: Division of Gastroenterology and Hepatology, University of Pittsburgh, 3471 Fifth Avenue, Suite 916, Pittsburgh, PA 15213.

Drs. Bryce and Roberts: Section for Decision Sciences and Clinical Systems Modeling, Division of General Internal Medicine, University of Pittsburgh, 200 Meyran Avenue, Pittsburgh, PA 15213.

Dr. Cacciarelli: Pittsburgh Veterans Affairs Healthcare System, University Drive, Pittsburgh, PA 15240.

Author Contributions: Conception and design: J. Ahmad, C.L. Bryce, M.S. Roberts.

Analysis and interpretation of the data: J. Ahmad, C.L. Bryce, T. Cacciarelli, M.S. Roberts.

Drafting of the article: J. Ahmad, C.L. Bryce, T. Cacciarelli.

Critical revision of the article for important intellectual content: J. Ahmad, C.L. Bryce, M.S. Roberts.

Final approval of the article: J. Ahmad, C.L. Bryce, T. Cacciarelli, M.S. Roberts.

Statistical expertise: J. Ahmad, C.L. Bryce.

Ann Intern Med. 2007;146(10):707-713. doi:10.7326/0003-4819-146-10-200705150-00004
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Table 1 describes the characteristics of the 20 075 patients in our sample who have received liver transplants from deceased donors since the advent of the MELD scoring system. In 2005, 63 centers performed fewer than 50 transplantations, 27 centers performed 50 to 99 transplantations, and 17 centers performed 100 or more transplantations (5). We found that 41% of patients received transplants at high-volume centers, compared with 33% in medium-volume centers and 26% in low-volume centers. High-volume centers used organs from statistically significantly older donors and recipient age increased with the volume of procedures, but recipients across the 3 volume categories were similar in sex, race or ethnicity, and blood type. The cause of liver disease among transplant recipients varied by center volume, with low-volume centers performing more transplantations for patients with hepatocellular carcinoma and high-volume centers performing more transplantations for recipients with other chronic diseases. The distribution of low-, medium-, and high-volume centers by location differed, with several UNOS regions having centers in only 1 or 2 categories.

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