Geographic Variation in XXXX Time: Kidney vs. Liver Transplantation in the United States, 2003-2011.

@entity7792 @entity63
BACKGROUND: Regional variations in kidney and liver transplant outcomes have been reported, but their causes remain largely unknown. This study investigated variations in kidney and liver cold @entity63 times (CITs) across Organ Procurement Organizations (OPO) as potential causes of variations in transplant outcomes. METHODS: This retrospective study analyzed the Standard Transplant Analysis and Research (STAR) data of deceased donor kidney (n=61,335) and liver (n=39,285) transplants performed between 2003 and 2011. @entity7792 variations between the two types of organs were examined and compared. Factors associated with @entity7792 were explored using multivariable regressions. Spearman's rank tests were used to associate @entity7792 with graft failure at the OPO level. RESULTS: Significant @entity7792 variations were found across OPOs for both organs (p < 0.05). The variation was particularly large for kidney @entity7792 . Those OPOs with longer average kidney @entity7792 were likely to have a lower graft survival rate (p=0.01). For liver, this association was insignificant (p=0.23). The regression analysis revealed sharp contrasts between the factors associated with kidney and liver CITs. High risk kidney transplant recipients and marginal kidneys were associated with longer average @entity7792 . The reverse was true for liver transplants. CONCLUSIONS: Large variations in kidney @entity7792 compared to liver @entity7792 may indicate that there is a room to reduce kidney @entity7792 . Reducing kidney @entity7792 through managerial improvements could be a cost effective way to improve the current transplant system.
