OPTN/SRTR 2022 Annual Data Report: Liver.

In 2022, liver transplant activity continued to increase in the United States, with an all-time high of 9,527 transplants performed, representing a 52% increase over the past decade (2012-2022). Of these transplants, 8,924 (93.7%) were from deceased donors and 603 (6.3%) were from living donors. Liver transplant recipients were 94.5% adult and 5.5% pediatric. The overall size of the liver transplant waiting list contracted, with more patients being removed than added, although 10,548 adult patients still remained on the waiting list at the end of 2022. Alcohol-associated liver disease continued to be the leading diagnosis among both candidates and recipients, followed by metabolic dysfunction-associated steatohepatitis. Simultaneous liver-kidney transplant was the most common multiorgan combination, with 800 liver-kidney transplants performed in 2022; in addition, there were 303 new listings for kidney transplant via the safety net mechanism. Among adults added to the liver waiting list in 2021, 39.9% received a deceased donor liver transplant within 3 months; 45.7%, within 6 months; and 54.5%, within 1 year. Pretransplant mortality decreased to 12.3 deaths per 100 patient-years in 2022, although still 15.6% of removals from the waiting list were for death or being too sick for transplant. Graft and patient survival outcomes after deceased donor liver transplant improved, approximating pre-COVID-19 pandemic levels, with 5.1% mortality observed at 6 months; 6.8%, at 1 year; 12.7%, at 3 years; 19.8%, at 5 years; and 35.7%, at 10 years. Five-year graft and patient survival rates after living donor liver transplant exceeded those of deceased donor liver transplant. Candidates receiving model for end-stage liver disease exception points for hepatocellular carcinoma constituted 15.5% of transplants performed in 2022, with similar transplant rates and posttransplant outcomes compared to cases without hepatocellular carcinoma exception. In 2022, more pediatric liver transplant candidates were added to the waiting list and underwent transplant compared with either of the preceding 2 years, with an uptick in living donor liver transplant volume. Although pretransplant mortality has improved after the recent policy change prioritizing pediatric donors for pediatric recipients, still, in 2022, 50 children died or were removed from the waiting list for being too sick to undergo transplant. Posttransplant mortality among pediatric liver transplant recipients remained notable, with death occurring in 4.0% at 6 months, 6.0% at 1 year, 8.2% at 3 years, 9.8% at 5 years, and 13.9% at 10 years. Similar to adult living donor recipients, pediatric living donor recipients had better 5-year patient survival compared with deceased donor recipients.

Medicare Reimbursement in Hand and Upper Extremity Procedures: A 20-Year Analysis.

PURPOSE: Concern exists that Medicare physician fees for procedures have decreased over the past 20 years. The Centers for Medicare & Medicaid Services (CMS) is set to re-evaluate these physician fees in the near future for concern that these procedures are overvalued. Our study sought to analyze trends in Medicare reimbursement rates from 2000 to 2019 for the top 20 most billed hand and upper extremity surgical procedures at our institution. METHODS: The financial database of a single academic tertiary care center was queried to identify the Current Procedural Terminology codes most frequently utilized in orthopedic hand and upper extremity procedures in 2019. The Physician Fee Schedule Look-Up Tool from the CMS was queried for annual physician fee data. Monetary data were adjusted for inflation using the consumer price index of Urban Research Series (CPI-U-RS) and expressed in 2019 constant US dollars (USD). The average annual and total percent change in reimbursement were calculated via linear regression for all procedures (P < .05). RESULTS: Accounting for inflation, the total average physician reimbursement decreased by 20.9% from 2000 to 2019, with 12 of 20 codes decreasing by more than 20%. The greatest decrease pertained to arthrodesis of the wrist at 33.9%. Upon linear regression, all procedures were found to decrease annually, with arthrodesis of the wrist decreasing by an average of 2.3% annually over this period. CONCLUSIONS: Over the past 2 decades, physician reimbursement for hand and upper extremity procedures has significantly decreased.

OPTN/SRTR 2021 Annual Data Report: Liver.

In 2021, liver transplant volume continued to grow, with a record 9,234 transplants performed in the United States, 8,665 (93.8%) from deceased donors and 569 (6.2%) from living donors. There were 8,733 (94.6%) adult and 501 (5.4%) pediatric liver transplant recipients. An increase in the number of deceased donor livers corresponded to an increase in the overall transplant rate and shorter waiting times, although still 10.0% of livers that were recovered were not transplanted. Alcohol-associated liver disease was the leading indication for both waitlist registration and liver transplant in adults, outpacing nonalcoholic steatohepatitis, while biliary atresia remained the leading indication for children. Related to allocation policy changes implemented in 2019, the proportion of liver transplants performed for hepatocellular carcinoma has decreased. Among adult candidates listed for liver transplant in 2020, 37.7% received a deceased donor liver transplant within 3 months, 43.8% within 6 months, and 53.3% within 1 year. Pretransplant mortality improved for children following implementation of acuity circle-based distribution. Short-term graft and patient survival outcomes up to 1 year worsened for adult deceased and living donor liver transplant recipients, which is a reversal of previous trends and coincided with the onset of the COVID-19 pandemic in early 2020. Longer-term outcomes among adult deceased donor liver transplant recipients were unaffected, with overall posttransplant mortality rates of 13.3% at 3 years, 18.6% at 5 years, and 35.9% at 10 years. Pretransplant mortality improved for children following implementation of acuity circle-based distribution and prioritization of pediatric donors to pediatric recipients in 2020. Pediatric living donor recipients had superior graft and patient survival outcomes compared with deceased donor recipients at all time points.

The Independent Effects of Procurement Biopsy Findings on 10-Year Outcomes of Extended Criteria Donor Kidney Transplants.

Introduction: The role of procurement biopsies in deceased donor kidney evaluation is debated in light of uncertainty about the influence of biopsy findings on recipient outcomes. The literature is filled with conflicting and ambiguous findings typically derived from small studies focused on short-term outcomes or reliant on biopsies prepared by methods impractical in the time-sensitive context of organ procurement. Methods: After manual data entry of DonorNet attachments from 4480 extended criteria donors (ECDs) recovered in the United States from 2008 to 2012, we applied causal inference methods in a Cox regression framework to estimate independent effects of glomerulosclerosis (GS), interstitial fibrosis, and vascular changes on long-term kidney graft survival. Kidney discard rates from 2018 to 2019 were evaluated to characterize contemporary kidney utilization patterns. Results: Effects of interstitial fibrosis and vascular changes were largely attenuated after adjusting for potentially confounding donor and recipient variables, although conclusions are less certain for severe levels due to smaller sample sizes. By contrast, significant effects of GS (>10% vs. 0%-5%) persisted even after adjustment (all-cause, hazard ratio [HR] 1.18; 95% CI 1.06, 1.28; death-censored, HR 1.28; 95% CI 1.08, 1.46) but plateaued beyond 10%. By contrast, kidney discard rates increased precipitously as GS rose >10%. Conclusion: Despite being obtained under less than ideal conditions, estimated GS from a procurement biopsy is independently associated with long-term graft survival, above and beyond standard clinical parameters, in ECD transplants. However, the disproportionately high likelihood of discard for kidneys with GS >10% is unjustified. The outsized effect of GS on kidney utilization should be tempered and commensurate with its effect on outcomes.

Intraosseous hibernoma: Two case reports and a review of the literature.

Intraosseous hibernomas are exceedingly rare tumors with only 35 cases reported worldwide. They are composed of vestigial brown adipose tissue and require biopsy and pathologic analysis for definitive diagnosis. Given their propensity to mimic more insidious malignant neoplasms, early and accurate identification may spare the patient both anxiety and invasive therapeutic interventions. In this report, we present two cases of intraosseous hibernomas and provide a review of current literature to further characterize the clinical, radiographic, and histopathologic parameters of these lesions. Clinicians should consider the diagnosis of intraosseous hibernoma when evaluating patients with characteristic presentations as it may be more prevalent than currently reported.

Adolescents' awareness and use of menu labels in eating establishments: results from a focus group study.

OBJECTIVE: Menu labelling has been identified as a potential strategy to help individuals make healthier choices when eating out. Although adolescents eat out often, little research involving menu labelling has been conducted with this population. The objectives of the present study were to: (i) gather qualitative information from adolescents regarding use of menu labels when eating out; (ii) gather adolescents' suggestions for optimal ways to design menu labels; and (iii) examine differences between adolescents living in communities of different socio-economic status. DESIGN: Qualitative. Five focus groups of five to ten participants. SETTING: Austin, TX, USA, 2012. SUBJECTS: Forty-one adolescents living in diverse communities recruited using a snowballing technique at public and private recreation centres (twenty-four females; twenty-two African American). RESULTS: Participants reported that menu labelling, in general, does not influence food selections when eating out. Among participants living in low-income communities, food purchases were based on price, taste and familiarity. Among participants living in high-income areas, food purchases were based on quality and ability to satiate (among boys). According to participants, effective ways to present menu labels are by matching calorie levels with physical activity equivalents or through simple graphics. CONCLUSIONS: For adolescents, providing menu labels in their current format may not be an effective strategy to increase healthy food selection. Given that the current menu label format has been set by federal policy in the USA cannot be easily changed, research to determine how this format can be best presented or enhanced so that it can have an impact on all US sub-populations is warranted.