Table 1. DSA, patient, and transplant characteristics of DSA quartiled by MELD score at transplant/censoringa.
| Quartile 1 | Quartile 2 | Quartile 3 | Quartile 4 | P | |
|---|---|---|---|---|---|
| DSA characteristics | |||||
| No. DSAs in quartile | 12 | 12 | 12 | 12 | |
| DSA size | 756.9±21 | 586.0±24 | 689.2±21 | 1849± 139 | <.001 |
| Transplant centers per DSA | 2.2±0.6 | 2.4±0.7 | 3.1±0.6 | 5.4±0.4 | <.001 |
| Eligible deaths per million | 75.6±5.8 | 89.9±4.7 | 91.2±4.6 | 75.4±3.6 | 0.973 |
| Eligible deaths recovered per million | 40.1±2.8 | 48.2±2.2 | 43.6±2.2 | 40.2±1.7 | 0.685 |
| Conversion rate | 55.2±3.0 | 54.0±2.5 | 48.5±2.4 | 53.7± 1.9 | 0.371 |
| Total deaths recovered per million | 43.7±3.6 | 51.7±2.9 | 46.0±2.8 | 44.6±2.2 | 0.822 |
| Liver donors per million | 35.0±3.0 | 42.8±2.4 | 38.1±2.4 | 35.4±1.9 | 0.757 |
| New listings per milliona | 16.9±3.3 | 21.6±2.7 | 23.2±2.6 | 27.9±2.1 | 0.008 |
| Patient characteristics | |||||
| Age (yr) | 52.8±0.3 | 52.4±0.2 | 52.3±0.2 | 53.2±0.3 | 0.513 |
| Male | 67.4±0.8 | 66.6±1.0 | 68.0±1.6 | 68.6±0.9 | 0.255 |
| Race (%) | |||||
| White | 80.2±2.6 | 80.2±2.3 | 77.6±3.4 | 62.3±4.2 | 0.005 |
| Black | 9.0±2.6 | 6.8± 1.6 | 8.4±3.0 | 21.5±4.0 | 0.023 |
| Hispanic | 7.3±0.9 | 10.3± 1.7 | 10.3± 1.3 | 8.0±1.3 | 0.669 |
| Asian | 2.6±0.8 | 2.1±0.4 | 2.7±0.7 | 6.9± 1.6 | 0.022 |
| Other | 1.0±0.4 | 0.7±0.2 | 0.9±0.4 | 1.2±0.3 | 0.42 |
| Blood type (%) | |||||
| O | 48.0±0.5 | 46.3± 1.1 | 46.5±0.8 | 46.2±0.8 | 0.134 |
| A | 38.5±0.6 | 38.3±0.8 | 39.1±0.9 | 36.7±0.8 | 0.197 |
| B | 10.9±0.4 | 11.7±0.7 | 11.5±0.6 | 12.9±0.5 | 0.021 |
| AB | 2.7±0.2 | 3.8±0.3 | 2.8±0.3 | 4.1±0.2 | 0.007 |
| Diagnosis (%) | |||||
| Noncholestatic cirrhosis | 73.1±2.0 | 70.0±2.5 | 72.1 ±2.1 | 71.9±3.0 | 0.905 |
| Malignant neoplasms | 7.1 ± 1.6 | 8.8±1.3 | 3.3 ±1.1 | 6.8± 1.3 | 0.293 |
| Cholestatic liver disease | 8.9±0.6 | 9.0±1.0 | 8.2±0.8 | 5.7±0.5 | 0.007 |
| Metabolic diseases | 2.0±0.2 | 2.6±0.4 | 2.6±0.4 | 1.5±0.2 | 0.122 |
| Other | 8.9± 1.4 | 9.6± 1.6 | 13.8±2.8 | 14.1 ±3.4 | 0.113 |
| Transplant characteristics | |||||
| Percent transplanted | 83.8±2.1 | 80.6±1.2 | 68.6±1.5 | 57.9± 1.5 | <.001 |
| Transplant rate (% per patient mo) | 4.8±0.4 | 3.1±0.5 | 1.6±0.4 | 1.0±0.3 | <.001 |
| Death rate (% per patient yr) | 0.13±0.01 | 0.14±0.01 | 0.20±0.01 | 0.21±0.01 | <.001 |
| MELD at transplant or censoring | 22.0±0.2 | 23.2±0.2 | 23.5±0.1 | 25.4±0.3 | <.001 |
| MELD at transplant | 22.2±0.2 | 23.4±0.2 | 24.4±0.2 | 28.0±0.5 | <.001 |
| MELD at listing (study population) | 21.1±0.2 | 21.8±0.2 | 21.8±0.1 | 22.9±0.3 | <.001 |
| Transplants at MELD <15 (%)a | 10.0±3.3 | 3.6±0.8 | 8.2±3.2 | 3.9± 1.2 | 0.197 |
| MELD when added to waitlista | 17.4±0.4 | 18.6±0.3 | 17.4±0.3 | 17.3±0.3 | 0.355 |
| Donation after cardiac death (%) | 4.9±1.7 | 4.6±0.9 | 4.1 ± 1.2 | 4.0±0.5 | 0.583 |
| Cold ischemia time | 7.3±0.1 | 6.9±0.3 | 7.9±0.4 | 7.3±0.4 | 0.374 |
| Cold ischemia time: imported organs | 7.8±0.3 | 8.0±0.6 | 9.1±0.6 | 8.9±0.4 | 0.103 |
| Cold ischemia time: organs within DSA | 7.0±0.1 | 6.7±0.3 | 7.5±0.4 | 6.9±0.3 | 0.554 |
| Relisted within 30 days of transplant | 3.0±0.3 | 3.1±0.3 | 4.0±0.4 | 3.9±0.6 | 0.122 |
| DRI | 1.5±0.05 | 1.5±0.02 | 1.5±0.03 | 1.6±0.06 | 0.393 |
| DRI: imported organs | 1.8±0.04 | 1.7±0.03 | 1.8±0.05 | 1.9±0.08 | 0.152 |
| DRI: organs from within DSA | 1.4±0.02 | 1.4±0.02 | 1.4±0.02 | 1.5±0.03 | 0.045 |
| Transplants from living donors (%)a | 0.4±0.2 | 0.8±0.5 | 3.9± 1.8 | 8.6± 1.3 | <.001 |
| Percent transplants with imported organs | 26.6±7.2 | 11.6±3.2 | 20.5±4.9 | 15.5±4.1 | 0.381 |
| Percent recovered organs exported | 23.5±5.2 | 21.8±5.7 | 27.6±6.6 | 7.8±1.4 | 0.018 |
| Dual listing | 0.27±0.11 | 0.35±0.06 | 1.10±0.43 | 0.98±0.12 | 0.003 |
| Life support at time of transplant (%) | 2.3±0.3 | 2.1±0.4 | 3.1±0.6 | 6.3±2.0 | 0.03 |
| Length of hospital stay | 14.3±0.5 | 15.3±0.6 | 18.5± 1.6 | 16.9± 1.2 | 0.03 |
DSAs were grouped into quartiles 1–4 by increasing corrected MELD at transplant. For certain analyses of transplant characteristics, patients outside the study population were considered included: MELD score < 15 and living donor transplants. Eligible deaths include patients younger than 70 yr who meet brain death criteria. Eligible deaths recovered are those eligible deaths from whom organs are recovered. Total recovered include donation after cardiac death and donors older than 70 yr. Conversion rate is the total eligible deaths leading to recovered organs divided by the total eligible deaths (data not shown). New listings/capita include all patients listed including those at MELD score < 15. Per capita donor data and listing data were analyzed for years 2002–2003 because of reliance on year 2000 census data and significant time-dependent changes in population. Patient characteristics, except age, are reported as percents ± SE. Age is expressed in yr.
Percent transplants before MELD score 15, MELD when added to waitlist, and transplants from living donors includes all patients in the 48 DSAs analyzed of any MELD. MELD at listing (study population) includes only those patients with two MELD scores > 15. A single DSA with more than 10% dual listing at its neighbor DSA, one of whose centers has transplant staff and patients in common with a center in the neighboring DSA, was excluded from the dual listing analysis as an outlier.
DSA, donation service area; MELD, Model for End-Stage Liver Disease; DRI, donor risk index; SE, standard error.