{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T10:24:37Z","timestamp":1775211877932,"version":"3.50.1"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2021,11,16]],"date-time":"2021-11-16T00:00:00Z","timestamp":1637020800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2021,11,16]],"date-time":"2021-11-16T00:00:00Z","timestamp":1637020800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:p>Despite a documented survival benefit, older liver donor (OLD, age \u226570) graft offers are frequently declined, with utilization worsening over the last decade. To understand how offer acceptance varies by center, we studied 1113 eventually transplanted OLD grafts from 2009 to 2017 using Scientific Registry of Transplant Recipients (SRTR) data and random\u2010intercept multilevel logistic regression. To understand how center\u2010level acceptance of OLD graft offers might be associated with waitlist and posttransplant outcomes, we studied all adult, actively listed, liver\u2010only candidates and recipients during the study period using Poisson regression (transplant rate), competing risks regression (waitlist mortality), and Cox regression (posttransplant mortality). Among 117 centers, OLD offer acceptance ranged from 0 (23 centers) to 95 acceptances, with a median odds ratio of 2.88. Thus, a candidate may be three times as likely to receive an OLD graft simply by listing at a different center. Centers in the highest quartile (Q4) of OLD acceptance (accepted 39% of OLD offers) accepted more nationally shared organs (Q4 versus Q1: 14.1% versus 0.0%, <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001) and had higher annual liver transplant volume (Q4 versus Q1: 80 versus 21, <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001). After adjustment, nationally shared OLD offers (adjusted odds ratio [aOR]: 0.16, 95% confidence interval [CI]: 0.13\u20100.20) and offers to centers with higher median Model for End\u2010Stage Liver Disease (MELD) at transplant (aOR: 0.74, 95% CI: 0.62\u20100.87) were less likely to be accepted. OLD offers to centers with higher annual transplant volume were more likely to be accepted (aOR: 1.21, 95% CI: 1.14\u20101.30). Additionally, candidates listed at centers within the highest quartile of OLD graft offer acceptance had higher deceased donor liver transplantation (DDLT) rates (adjusted incidence rate ratio: 1.45, 95% CI: 1.41\u20101.50), lower waitlist mortality (adjusted subhazard ratio: 0.76, 95% CI: 0.72\u20100.76), and similar posttransplant survival (adjusted hazard ratio: 0.93, 95% CI: 0.86\u20101.01) when compared with those listed at centers in the lowest quartile of OLD graft offer acceptance. The wide variation in OLD offer acceptance supports the need for optimizing the organ offer process and efficiently directing OLD offers to centers more likely to use them.<\/jats:p>","DOI":"10.1002\/lt.26309","type":"journal-article","created":{"date-parts":[[2021,9,24]],"date-time":"2021-09-24T13:31:52Z","timestamp":1632490312000},"page":"571-580","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":8,"title":["Offer Acceptance Patterns for Liver Donors Aged 70 and Older"],"prefix":"10.1097","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5884-2604","authenticated-orcid":false,"given":"Christine E.","family":"Haugen","sequence":"first","affiliation":[{"name":"Department of Surgery,Johns Hopkins University School of Medicine,Baltimore,MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7299-7730","authenticated-orcid":false,"given":"Mary G.","family":"Bowring","sequence":"additional","affiliation":[{"name":"Department of Surgery,Johns Hopkins University School of Medicine,Baltimore,MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyle R.","family":"Jackson","sequence":"additional","affiliation":[{"name":"Department of Surgery,Johns Hopkins University School of Medicine,Baltimore,MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline","family":"Garonzik\u2010Wang","sequence":"additional","affiliation":[{"name":"Department of Surgery,Johns Hopkins University School of Medicine,Baltimore,MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allan B.","family":"Massie","sequence":"additional","affiliation":[{"name":"Department of Surgery,Johns Hopkins University School of Medicine,Baltimore,MD"},{"name":"Department of Epidemiology,Johns Hopkins School of Public Health,Baltimore,MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teresa Po\u2010Yu","family":"Chiang","sequence":"additional","affiliation":[{"name":"Department of Surgery,Johns Hopkins University School of Medicine,Baltimore,MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Philosophe","sequence":"additional","affiliation":[{"name":"Department of Surgery,Johns Hopkins University School of Medicine,Baltimore,MD"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dorry L.","family":"Segev","sequence":"additional","affiliation":[{"name":"Department of Surgery,Johns Hopkins University School of Medicine,Baltimore,MD"},{"name":"Department of Epidemiology,Johns Hopkins School of Public Health,Baltimore,MD"},{"name":"Scientific Registry of Transplant Recipients,Minneapolis,MN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karim J.","family":"Halazun","sequence":"additional","affiliation":[{"name":"Department of Surgery,Weill Cornell Medicine,New York,NY"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2021,11,16]]},"reference":[{"key":"lt26309-bib-0001-20250824","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1001\/jamasurg.2018.5568","article-title":"Assessment of trends in transplantation of liver grafts from older donors and outcomes in recipients of liver grafts from older donors, 2003\u20102016","volume":"154","year":"2019","journal-title":"JAMA Surg"},{"key":"lt26309-bib-0002-20250824","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1111\/ajt.14518","article-title":"No country for old livers? Examining and optimizing the utilization of elderly liver grafts","volume":"18","year":"2018","journal-title":"Am J Transplant"},{"key":"lt26309-bib-0003-20250824","doi-asserted-by":"crossref","first-page":"1649","DOI":"10.1111\/ajt.14163","article-title":"Noneligible donors as a strategy to decrease the organ shortage","volume":"17","year":"2017","journal-title":"Am J Transplant"},{"key":"lt26309-bib-0004-20250824","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1002\/lt.23547","article-title":"Declining liver utilization for transplantation in the United States and the impact of donation after cardiac death","volume":"19","year":"2013","journal-title":"Liver Transpl"},{"key":"lt26309-bib-0005-20250824","doi-asserted-by":"crossref","first-page":"2020","DOI":"10.1111\/ajt.15250","article-title":"Survival benefit of accepting livers from deceased donors over 70 years old","volume":"19","year":"2019","journal-title":"Am J 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