Resource Utilization in Liver Transplantation: Effects of Patient Characteristics and Clinical Practice

Showstack, Jonathan; Katz, Patricia P.; Lake, John R.; Brown, Robert S.; Dudley, R. Adams; Belle, Steven H.; Wiesner, Russell H.; Zetterman, Rowen K.

doi:10.1097/00132586-200002000-00016

Cited by 88 publications

(171 citation statements)

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“…10,11 We analyzed a cohort that traditionally incurs higher charges and uses more resources by using resource variables that account for most of the charges incurred during OLT. [12][13][14] Room and care charges, which are directly related to LOS, and treatments, including operating room charges and blood product use, account for up to two Our study using patients undergoing OLT at a single center eliminated other variations in clinical practices across transplant centers that may affect resource utilization, such as differences in surgical techniques, immunosuppression protocols, clinical expertise of transplant professionals, and immediate post-OLT management, as well as differences in severity of disease caused by regional differences in organ procurement and allocation. 14 Also, our sample was accrued over a relatively short period of 2 years, minimizing the role of improvements in peri-OLT management in results observed.…”

Section: Discussionmentioning

confidence: 99%

Model for end-stage liver disease and Child-Turcotte-Pugh score as predictors of pretransplantation disease severity, posttransplantation outcome, and resource utilization in United Network for Organ Sharing status 2A patients

Brown

Kumar

Russo

et al. 2002

Liver Transplantation

203

123

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Section: Discussionmentioning

confidence: 99%

Model for end-stage liver disease and Child-Turcotte-Pugh score as predictors of pretransplantation disease severity, posttransplantation outcome, and resource utilization in United Network for Organ Sharing status 2A patients

Brown

Kumar

Russo

et al. 2002

Liver Transplantation

203

123

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“…Recent reports documented that transplantation of more ill patients results in increased costs of liver transplantation. 8,9 This disease severity scale more frequently directs organs to the more ill patients because less ill patients with longer waiting times no longer reach the highest priority. Because there is a reduction in the frequency of transplantation for the patients who are less ill, such a system is likely to increase the cost of liver transplantation.…”

Section: Discussionmentioning

confidence: 99%

Preliminary results of a liver allocation plan using a continuous medical severity score that de-emphasizes waiting time

et al. 2001

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Liver allocation remains problematic because current policy prioritizes status 2B or 3 patients by waiting time rather than medical urgency. On February 21, 2000, we implemented a variance to the United Network for Organ Sharing liver allocation policy that redefined status 2A by much more rigid, definable criteria and prioritized status 2B patients by using a continuous medical urgency score based on the Child-Turcotte-Pugh score and other medical conditions. In this system, waiting time is used only to differentiate status 2B candidates with equal medical urgency scores. Comparing the 6-month period (period 1; n ‫؍‬ 67) before implementation of this system to the 6-month period after implementation (period 2; n ‫؍‬ 75), there was a significant reduction in the number of transplantations performed for patients listed as status 2A (46.3% to 14.7%; P ‫؍‬ .002) and an increase in the number of patients listed as status 2B who received transplants (44.8% to 70.7%; P ‫؍‬ .10). Most dramatically, there was a 37.1% reduction in overall deaths on the waiting list from 94 deaths in period 1 to 62 deaths in period 2 (P ‫؍‬ .005), with the most significant reduction for patients removed from this list at status 2B (52 v 18 patients; P ‫؍‬ .04). There were 3 postoperative deaths in each period, with only 1 graft lost in period 2. Status 2B patients with the greatest degree of medical urgency received transplants without multiple peer reviews requesting elevation to 2A status. We conclude that a continuous medical urgency score system allocates donor livers much more fairly to those in medical need and reduces waiting list mortality without sacrificing efficacy. (Liver Transpl 2001;7: 173-178.)

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“…T he expansion of liver transplantation (LT) as a treatment modality for end-stage liver disease has led to considerable organ shortage 1 and substantially lengthened the waiting time, thus leading to increased mortality on the liver waiting list 1,2 and, with sicker patients undergoing LT, increased mortality and costs after LT. 3,4 Accurate evaluation of the prognosis of patients with cirrhosis therefore is becoming increasingly important to define the optimum time to refer and list a patient for LT.…”

mentioning

confidence: 99%

Predictive models of short- and long-term survival in patients with nonbiliary cirrhosis

Longheval

Vereerstraeten

Thiry

et al. 2003

Liver Transplantation

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The limited number of donor organs has placed a burden on the medical community to improve patient selection and timing of liver transplantation (LT). We aim to evaluate short-and long-term survival of 124 consecutive patients with a diagnosis of nonbiliary cirrhosis. Seventeen clinical, biochemical, functional, and hemodynamic parameters were computed. Patient survival was evaluated in the short term (3 months) by logistic regression, and the predictive power of the model was evaluated using receiver operating characteristic curves and the log likelihood ratio. For the long-term (up to 5 years) prognosis, the Cox proportional model was used. During follow-up, 54 patients died and 20 patients underwent LT. In the short-term study, the Model for End-Stage Liver Disease score (including bilirubin level, international normalized ratio [INR], and creatinine level) was as predictive as our score, which contained only two independent indicators (bilirubin and creatinine levels). In the long-term study, three independent variables (albumin level, INR, and creatinine level) emerged from the Cox model, and patients were classified into three survival-risk groups according to a prognostic index (PI): ؊1.039 ؋ albumin (grams per deciliter) ؉ 1.909 ؋ log e INR ؉ 1.207 ؋ log e serum creatinine (milligrams per deciliter). Survival probabilities at 1 and 5 years were 89% and 80%, 63% and 52%, and 23% and 10% with a low, medium, and high PI, respectively. The validation study using the split-sample technique and data from independent patients confirmed that a high PI (>؊2.5) identifies patients with a poor prognosis within 5 years. We thus have shown and validated that risk for death at the short and long term of patients with nonbiliary cirrhosis can be predicted with great accuracy using models containing a few simple and easily obtained objective variables, and these survival models are useful tools in clinical decision making, especially in deciding to list patients for LT and prioritization on the liver waiting list. (Liver Transpl 2003;9:260-267.)

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Resource Utilization in Liver Transplantation: Effects of Patient Characteristics and Clinical Practice

Cited by 88 publications

References 0 publications

Model for end-stage liver disease and Child-Turcotte-Pugh score as predictors of pretransplantation disease severity, posttransplantation outcome, and resource utilization in United Network for Organ Sharing status 2A patients

Model for end-stage liver disease and Child-Turcotte-Pugh score as predictors of pretransplantation disease severity, posttransplantation outcome, and resource utilization in United Network for Organ Sharing status 2A patients

Preliminary results of a liver allocation plan using a continuous medical severity score that de-emphasizes waiting time

Predictive models of short- and long-term survival in patients with nonbiliary cirrhosis

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