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To the Editor. The article by Dr Showstack and colleagues¹ regarding the effect of patient characteristics and clinical practice on resource use in liver transplantation includes several points the authors should address. First, the conclusion that patients with higher medical urgency have higher transplantation cost is not a novel finding and was demonstrated years ago.² The authors have not taken into account sufficient variables in patient characteristics to validate their other conclusion, namely, that variability in center practice accounts for large differences in costs for liver transplantation.

The authors failed to describe comparative interinstitutional demographics of patients undergoing transplantation. Table 1 in their article provides the demographic and clinical data for all study patients, yet the authors do not note whether there are real differences among the 3 institutions. According to United Network for Organ Sharing (UNOS) data, the percentage of patients undergoing transplantation while hospitalized ranged from 25% to . . . [Full Text of this Article]

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RELATED ARTICLE

Resource Utilization in Liver Transplantation: Effects of Patient Characteristics and Clinical Practice
Jonathan Showstack, Patricia P. Katz, John R. Lake, Robert S. Brown, Jr, R. Adams Dudley, Steven Belle, Russell H. Wiesner, Rowen K. Zetterman, James Everhart, and for the NIDDK Liver Transplantation Database Group
JAMA. 1999;281(15):1381-1386.
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