@article{ec0a1924c3474742a8e3d4a795a4ffb3,
title = "Variation in adult living donor liver transplantation in the United States: Identifying opportunities for increased utilization",
abstract = "In the United States, living donor liver transplantation (LDLT) is limited to transplant centers with specific experience. However, the impact of recipient characteristics on procedure selection (LDLT vs. deceased donor liver transplant [DDLT]) within these centers has not been described. Transplant registry data for centers that performed ≥1 LDLT in 2002–2019 were analyzed using hierarchal regression modeling to quantify the impact of patient and center factors on the adjusted odds ratio (aOR) of LDLT (vs DDLT). Among 73,681 adult recipients, only 4% underwent LDLT, varying from <1% to >60% of total liver transplants. After risk adjustment, the likelihood of receiving an LDLT rose by 73% in recent years (aOR 1.73 for 2014-2019 vs. 2002-2007) but remained lower for older adults, men, racial and ethnic minorities, and obese patients. LDLT was less commonly used in patients with hepatocellular carcinoma or alcoholic cirrhosis, and more frequently in those with hepatitis C and with lower severity of illness (Model for End-Stage Liver Disease (MELD) score < 15). Patients with public insurance, lower educational achievement, and residence in the Northwest and Southeast had decreased access. While some differences in access to LDLT reflect clinical factors, further exploration into disparities in LDLT utilization based on center practice and socioeconomic determinants of health is needed.",
keywords = "access, disparities, liver transplantation, living donation, practice variation, Severity of Illness Index, United States, Humans, Male, Treatment Outcome, Living Donors, Liver Neoplasms/pathology, End Stage Liver Disease/surgery, Aged, Retrospective Studies, Liver Transplantation/methods",
author = "Lentine, {Krista L.} and Tomohiro Tanaka and Huiling Xiao and Therese Bittermann and Dew, {Mary Amanda} and Schnitzler, {Mark A.} and Olthoff, {Kim M.} and Locke, {Jayme E.} and Sukru Emre and Hunt, {Heather F.} and Liapakis, {Ann Marie} and Axelrod, {David A.}",
note = "Funding Information: KLL is supported by a grant from National Institute of Diabetes and Digestive and Kidney Diseases (R01DK120518) and by the Mid-America Transplant/Jane A. Beckman Endowed Chair in Transplantation. This work was conducted under the auspices of the Hennepin Healthcare Research Institute (HHRI), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. 75R60220C00011 (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). The US government (and others acting on its behalf) retains a paidup, nonexclusive, irrevocable, worldwide license for all works produced under the SRTR contract, and to reproduce them, prepare derivative works, distribute copies to the public, and perform publicly and display publicly, by or on behalf of the Government. The data reported here have been supplied by HHRI as the contractor for SRTR. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by SRTR or the US Government. The authors thank: The LDLT Consensus Conference co-chairs (Michelle Jesse, Vineeta Kumar, Elizabeth Verna, and Anjana Pillai, along with co-chair and workgroup 1 member AnnMarie Liapakis) for review and feedback The American Society of Transplantation Education Committee for review and feedback, and SRTR colleague Anna Gillette for manuscript editing. An abstract describing portions of this work was shared as an oral presentation at the 2022 American Transplant Congress, June 5, 2022, Boston, MA. Funding Information: KLL is supported by a grant from National Institute of Diabetes and Digestive and Kidney Diseases (R01DK120518) and by the Mid‐America Transplant/Jane A. Beckman Endowed Chair in Transplantation. This work was conducted under the auspices of the Hennepin Healthcare Research Institute (HHRI), contractor for the Scientific Registry of Transplant Recipients (SRTR), as a deliverable under contract no. 75R60220C00011 (US Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation). The US government (and others acting on its behalf) retains a paidup, nonexclusive, irrevocable, worldwide license for all works produced under the SRTR contract, and to reproduce them, prepare derivative works, distribute copies to the public, and perform publicly and display publicly, by or on behalf of the Government. The data reported here have been supplied by HHRI as the contractor for SRTR. The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by SRTR or the US Government. Publisher Copyright: {\textcopyright} 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.",
year = "2023",
month = jul,
doi = "10.1111/ctr.14924",
language = "English (US)",
volume = "37",
pages = "e14924",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell Publishing Ltd",
number = "7",
}