Abstract：
BACKGROUND: Introducing new liver transplantation (LT) practices, like unconventional donor use, incurs higher costs, making evaluation of their prognostic justification crucial. This study reexamines the spread pattern of new LT practices and its prognosis across the United States.
METHODS: The study investigated the spread pattern of new practices using the UNOS database (2014-2023). Practices included LT for hepatitis B/C (HBV/HCV) nonviremic recipients with viremic donors, LT for COVID-19-positive recipients, and LT using onsite machine perfusion (OMP). One year post-LT patient and graft survival were also evaluated.
RESULTS: LTs using HBV/HCV donors were common in the East, while LTs for COVID-19 recipients and those using OMP started predominantly in California, Arizona, Texas, and the Northeast. K-means cluster analysis identified three adoption groups: facilities with rapid, slow, and minimal adoption rates. Rapid adoption occurred mainly in high-volume centers, followed by a gradual increase in middle-volume centers, with little increase in low-volume centers. The current spread patterns did not significantly affect patient survival. Specifically, for LTs with HCV donors or COVID-19 recipients, patient and graft survivals in the rapid-increasing group was comparable to others. In LTs involving OMP, the rapid- or slow-increasing groups tended to have better patient survival (p = 0.05) and significantly improved graft survival rates (p = 0.02). Facilities adopting new practices often overlap across different practices.
CONCLUSIONS: Our analysis revealed three distinct adoption groups across all practices, correlating the adoption aggressiveness with LT volume in centers. Aggressive adoption of new practices did not compromise patient and graft survivals, supporting the current strategy. Understanding historical trends could predict the rise in future LT cases with new practices, aiding in resource distribution.
METHODS: The study investigated the spread pattern of new practices using the UNOS database (2014-2023). Practices included LT for hepatitis B/C (HBV/HCV) nonviremic recipients with viremic donors, LT for COVID-19-positive recipients, and LT using onsite machine perfusion (OMP). One year post-LT patient and graft survival were also evaluated.
RESULTS: LTs using HBV/HCV donors were common in the East, while LTs for COVID-19 recipients and those using OMP started predominantly in California, Arizona, Texas, and the Northeast. K-means cluster analysis identified three adoption groups: facilities with rapid, slow, and minimal adoption rates. Rapid adoption occurred mainly in high-volume centers, followed by a gradual increase in middle-volume centers, with little increase in low-volume centers. The current spread patterns did not significantly affect patient survival. Specifically, for LTs with HCV donors or COVID-19 recipients, patient and graft survivals in the rapid-increasing group was comparable to others. In LTs involving OMP, the rapid- or slow-increasing groups tended to have better patient survival (p = 0.05) and significantly improved graft survival rates (p = 0.02). Facilities adopting new practices often overlap across different practices.
CONCLUSIONS: Our analysis revealed three distinct adoption groups across all practices, correlating the adoption aggressiveness with LT volume in centers. Aggressive adoption of new practices did not compromise patient and graft survivals, supporting the current strategy. Understanding historical trends could predict the rise in future LT cases with new practices, aiding in resource distribution.
摘要：
背景：引入新的肝移植（LT）实践，比如非常规的捐赠者使用，导致更高的成本，评估他们的预后理由至关重要。这项研究重新审视了新的LT实践的传播模式及其在美国的预后。
方法：该研究使用UNOS数据库（2014-2023年）调查了新实践的传播模式。实践包括LT为乙型肝炎/丙型肝炎（HBV/HCV）非病毒血症接受者与病毒血症供体，对于COVID-19阳性接受者，和LT使用现场机器灌注(OMP)。还评估了LT后一年的患者和移植物存活率。
结果：使用HBV/HCV供体的LTs在东部很常见，虽然COVID-19接受者和使用OMP的人的LTs主要在加利福尼亚州开始，亚利桑那,德州,和东北。K-means聚类分析确定了三个采用组：具有快速，慢,和最低采用率。快速采用主要发生在高容量中心，随后是中等数量中心的逐渐增加，在低容量中心几乎没有增加。目前的传播模式并没有显著影响患者的生存。具体来说,对于HCV捐赠者或COVID-19接受者的LTs，快速增加组的患者和移植物生存率与其他组相当.在涉及OMP的LTs中，快速或缓慢增加的组倾向于具有更好的患者生存率(p=0.05)和显著提高的移植物存活率(p=0.02).采用新做法的设施通常在不同做法之间重叠。
结论：我们的分析揭示了在所有实践中三个不同的采用群体，将采用积极性与中心的LT量相关联。积极采用新的做法并没有损害患者和移植物的生存，支持当前战略。了解历史趋势可以预测未来LT案件的增加与新的做法，协助资源分配。
方法：该研究使用UNOS数据库（2014-2023年）调查了新实践的传播模式。实践包括LT为乙型肝炎/丙型肝炎（HBV/HCV）非病毒血症接受者与病毒血症供体，对于COVID-19阳性接受者，和LT使用现场机器灌注(OMP)。还评估了LT后一年的患者和移植物存活率。
结果：使用HBV/HCV供体的LTs在东部很常见，虽然COVID-19接受者和使用OMP的人的LTs主要在加利福尼亚州开始，亚利桑那,德州,和东北。K-means聚类分析确定了三个采用组：具有快速，慢,和最低采用率。快速采用主要发生在高容量中心，随后是中等数量中心的逐渐增加，在低容量中心几乎没有增加。目前的传播模式并没有显著影响患者的生存。具体来说,对于HCV捐赠者或COVID-19接受者的LTs，快速增加组的患者和移植物生存率与其他组相当.在涉及OMP的LTs中，快速或缓慢增加的组倾向于具有更好的患者生存率(p=0.05)和显著提高的移植物存活率(p=0.02).采用新做法的设施通常在不同做法之间重叠。
结论：我们的分析揭示了在所有实践中三个不同的采用群体，将采用积极性与中心的LT量相关联。积极采用新的做法并没有损害患者和移植物的生存，支持当前战略。了解历史趋势可以预测未来LT案件的增加与新的做法，协助资源分配。
