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Geographic differences in access to transplantation in the United States.
Transplantation. 2003 Nov 15; 76(9):1389-94.T

Abstract

BACKGROUND

The Etablissement français des Greffes reports regional variability in access to organ transplantation in France. Some variability seems to be inevitable for reasons discussed in the French article. We provide comparative data on a similar phenomenon in the United States, including some historical perspectives and recent attempts to minimize geographic variability especially for patients in urgent need of liver transplants.

METHODS

To assess regional variability in access to heart, liver, and kidney transplants, a competing risks method was used. Outcomes were examined for primary transplant candidates added to the waiting list during 3-year periods. Results were stratified by region of listing.

RESULTS

Four months after listing, the transplant rate for all U.S. kidney transplant candidates was 10.9%. Regionally the 4-month transplant rate ranged from 4.2% to 18.5% for highly sensitized patients and from 5.4% to 19.6% for nonsensitized patients. For liver candidates, the overall national transplant rate 4 months after listing was 22%, but the overall regional rate varied from 11.8% to 36.5%. The overall transplant rate for heart candidates 4 months after listing was 43.9%, whereas regional 30-day transplant rates for the most urgent heart candidates (status 1A) ranged from 25.1% to 47.1%. Four-month transplant rates for less urgent heart candidates ranged from 24.9% to 40.7%.

CONCLUSION

Similar to the French experience, pretransplantation waiting times in the 11 U.S. regions vary considerably. Computer-simulated modeling shows that redrawing organ distribution boundaries could reduce but not eliminate geographic variability. It may be too early to tell whether the recently implemented Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease liver allocation system will decrease regional variability in access to transplant as compared with the previous system.

Authors+Show Affiliations

Research Department, United Network for Organ Sharing, Richmond, VA 23219, USA. ellisomd@unos.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

14627922

Citation

Ellison, Mary D., et al. "Geographic Differences in Access to Transplantation in the United States." Transplantation, vol. 76, no. 9, 2003, pp. 1389-94.
Ellison MD, Edwards LB, Edwards EB, et al. Geographic differences in access to transplantation in the United States. Transplantation. 2003;76(9):1389-94.
Ellison, M. D., Edwards, L. B., Edwards, E. B., & Barker, C. F. (2003). Geographic differences in access to transplantation in the United States. Transplantation, 76(9), 1389-94.
Ellison MD, et al. Geographic Differences in Access to Transplantation in the United States. Transplantation. 2003 Nov 15;76(9):1389-94. PubMed PMID: 14627922.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Geographic differences in access to transplantation in the United States. AU - Ellison,Mary D, AU - Edwards,Leah B, AU - Edwards,Erick B, AU - Barker,Clyde F, PY - 2003/11/25/pubmed PY - 2004/1/6/medline PY - 2003/11/25/entrez SP - 1389 EP - 94 JF - Transplantation JO - Transplantation VL - 76 IS - 9 N2 - BACKGROUND: The Etablissement français des Greffes reports regional variability in access to organ transplantation in France. Some variability seems to be inevitable for reasons discussed in the French article. We provide comparative data on a similar phenomenon in the United States, including some historical perspectives and recent attempts to minimize geographic variability especially for patients in urgent need of liver transplants. METHODS: To assess regional variability in access to heart, liver, and kidney transplants, a competing risks method was used. Outcomes were examined for primary transplant candidates added to the waiting list during 3-year periods. Results were stratified by region of listing. RESULTS: Four months after listing, the transplant rate for all U.S. kidney transplant candidates was 10.9%. Regionally the 4-month transplant rate ranged from 4.2% to 18.5% for highly sensitized patients and from 5.4% to 19.6% for nonsensitized patients. For liver candidates, the overall national transplant rate 4 months after listing was 22%, but the overall regional rate varied from 11.8% to 36.5%. The overall transplant rate for heart candidates 4 months after listing was 43.9%, whereas regional 30-day transplant rates for the most urgent heart candidates (status 1A) ranged from 25.1% to 47.1%. Four-month transplant rates for less urgent heart candidates ranged from 24.9% to 40.7%. CONCLUSION: Similar to the French experience, pretransplantation waiting times in the 11 U.S. regions vary considerably. Computer-simulated modeling shows that redrawing organ distribution boundaries could reduce but not eliminate geographic variability. It may be too early to tell whether the recently implemented Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease liver allocation system will decrease regional variability in access to transplant as compared with the previous system. SN - 0041-1337 UR - https://www.unboundmedicine.com/medline/citation/14627922/Geographic_differences_in_access_to_transplantation_in_the_United_States_ L2 - http://dx.doi.org/10.1097/01.TP.0000090332.30050.BA DB - PRIME DP - Unbound Medicine ER -