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Transplant Center Variation in Use of Steatotic Donor Livers
*David C Cron1, *Heidi Yeh1, James F Markmann1, *David C Chang1, *Joel T Adler2
1Massachusetts General Hospital, Boston, MA;2Brigham and Women's Hospital, Boston, MA

Objective: Steatotic donor livers (SDLs) provide an opportunity to increase supply of available organs. Some transplant centers are more aggressive than others in their use of such marginal livers. We studied variation in steatotic donor liver transplants across centers.
Design: Observational study, Scientific Registry of Transplant Recipients database.
Setting: 142 U.S. transplant centers.
Patients: All U.S. adult recipients of deceased donor liver transplants 2009-2018.
Main Outcome Measure: SDLs were defined as livers with biopsy-proven macrosteatosis ≥30%. We compared SDL use (proportion of all transplants) by center. Multilevel logistic regression was used to identify center characteristics associated with SDL transplants, adjusting for recipient/donor characteristics.
Results: A total of 60,906 liver transplant recipients were included, and 1,931 (3.2%) received an SDL. Proportion of SDL transplants varied from 0% (N=32) to 12.3% across transplant centers (Figure). High vs. low (tertile) SDL centers had higher annual volume (62 vs. 17, P<0.01), older average recipient age (56 vs. 40, P<0.01), higher mean donor risk index (1.7 vs. 1.4, P<0.01), greater market competition (0.5 vs. 0.4 on a 0 to 1 scale, P=0.02), and equivalent average lab MELD (23 vs. 22, P=0.43). After adjusting for recipient/donor factors, higher mean donor risk index (OR=1.5 per 0.1 point increase, P<0.01) was the only center characteristic significantly associated with SDL transplants.
Conclusion: Use of SDLs varies across transplant centers, driven in part by a center’s overall willingness to transplant higher risk organs. Understanding such differences in use of marginal organs may help increase the number of transplanted livers.


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