Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Liver Transpl. 2018 Apr;24(4):478-487. doi: 10.1002/lt.25010.
Offer acceptance practices may cause geographic variability in allocation Model for End-Stage Liver Disease (aMELD) score at transplant and could magnify the effect of donor supply and demand on aMELD variability. To evaluate these issues, offer acceptance practices of liver transplant programs and donation service areas (DSAs) were estimated using offers of livers from donors recovered between January 1, 2016, and December 31, 2016. Offer acceptance practices were compared with liver yield, local placement of transplanted livers, donor supply and demand, and aMELD at transplant. Offer acceptance was associated with liver yield (odds ratio, 1.32; P < 0.001), local placement of transplanted livers (odds ratio, 1.34; P < 0.001), and aMELD at transplant (average aMELD difference, -1.62; P < 0.001). However, the ratio of donated livers to listed candidates in a DSA (ie, donor-to-candidate ratio) was associated with median aMELD at transplant (r = -0.45; P < 0.001), but not with offer acceptance (r = 0.09; P = 0.50). Additionally, the association between DSA-level donor-to-candidate ratios and aMELD at transplant did not change after adjustment for offer acceptance. The average squared difference in median aMELD at transplant across DSAs was 24.6; removing the effect of donor-to-candidate ratios reduced the average squared differences more than removing the effect of program-level offer acceptance (33% and 15% reduction, respectively). Offer acceptance practices and donor-to-candidate ratios independently contributed to geographic variability in aMELD at transplant. Thus, neither offer acceptance nor donor-to-candidate ratios can explain all of the geographic variability in aMELD at transplant. Liver Transplantation 24 478-487 2018 AASLD.
接受肝移植的建议的做法可能导致移植时终末期肝病模型（aMELD）评分的地理变异性，并可能放大供体供应和需求对 aMELD 变异性的影响。为了评估这些问题，使用 2016 年 1 月 1 日至 2016 年 12 月 31 日期间从供体中回收的肝脏的建议来估计肝移植计划和捐赠服务区域（DSA）的接受建议。将接受建议的做法与肝脏产量、移植肝脏的本地放置、供体供应和需求以及移植时的 aMELD 进行了比较。接受建议与肝脏产量（优势比，1.32；P<0.001）、移植肝脏的本地放置（优势比，1.34；P<0.001）和移植时的 aMELD（平均 aMELD 差异，-1.62；P<0.001）有关。然而，DSA 内捐赠肝脏与列出的候选人的比例（即供体与候选人的比例）与移植时的中位数 aMELD 相关（r=-0.45；P<0.001），但与接受建议无关（r=0.09；P=0.50）。此外，调整接受建议后，DSA 水平供体与候选人比例与移植时的 aMELD 之间的关联并未改变。DSA 间移植时中位数 aMELD 的平均平方差异为 24.6；去除供体与候选人比例的影响比去除计划水平接受建议的影响更大（分别减少 33%和 15%）。接受建议的做法和供体与候选人的比例独立导致移植时 aMELD 的地理变异性。因此，接受建议和供体与候选人的比例都不能解释移植时 aMELD 的所有地理变异性。肝移植 24 478-487 2018 AASLD。
