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December 8, 1999


Author Affiliations

Phil B.FontanarosaMD, Interim CoeditorIndividualAuthorMargaret A.WinkerMD, Deputy EditorIndividualAuthorStephenLurieMD PhD, Fishbein FellowIndividualAuthor

JAMA. 1999;282(22):2123-2124. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-22-jbk1208

In Reply. Due to changes in clinical practices over time, the data cited by Dr Fung from UNOS center-specific graft and patient survival rates for 1997 are not necessarily comparable with our data for patients who received transplants during 1990 to 1995. For example, hepatitis B immunoglobulin was not used routinely by any of the 3 centers during the first years of the study, and there was little difference among the 3 centers in the number of patients with hepatitis B. Cytomegalovirus prophylaxis did not differ significantly among the 3 centers; all centers used regimens that consisted of intravenous ganciclovir, acyclovir, or both; and analyses controlled for donor and recipient CMV status. Finally, the transfer of patients from the transplantation hospital to a lower-cost facility rarely occurred in this era. Thus, the differences found in resource use among the 3 centers were unlikely to have been caused by the factors suggested by Fung.