One Size Does Not Fit All—Regional Variation in the Impact of the Share 35 Liver Allocation Policy |
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| Authors: | K. J. Halazun A. K. Mathur A. A. Rana A. B. Massie S. Mohan R. E. Patzer J. P. Wedd B. Samstein R. M. Subramanian B. D. Campos S. J. Knechtle |
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| Affiliation: | 1. Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY;2. Department of Surgery and Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ;3. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Phoenix, AZ;4. Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX;5. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD;6. Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD;7. Center for Liver Disease and Transplantation, Columbia University Medical Center, NY Presbyterian Hospital, New York, NY;8. Emory Transplant Center, Emory University Hospital, Atlanta, GA;9. Duke Transplant Center, Duke University Hospital, Durham, NC |
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| Abstract: | Allocation policies for liver transplantation underwent significant changes in June 2013 with the introduction of Share 35. We aimed to examine the effect of Share 35 on regional variation in posttransplant outcomes. We examined two patient groups from the United Network for Organ Sharing dataset; a pre–Share 35 group composed of patients transplanted between June 17, 2012, and June 17, 2013 (n = 5523), and a post–Share group composed of patients transplanted between June 18, 2013, and June 18, 2014 (n = 5815). We used Kaplan–Meier and Cox multivariable analyses to compare survival. There were significant increases in allocation Model for End‐stage Liver Disease (MELD) scores, laboratory MELD scores, and proportions of patients in the intensive care unit and on mechanical, ventilated, or organ‐perfusion support at transplant post–Share 35. We also observed a significant increase in donor risk index in this group. We found no difference on a national level in survival between patients transplanted pre–Share 35 and post–Share 35 (p = 0.987). Regionally, however, posttransplantation survival was significantly worse in the post–Share 35 patients in regions 4 and 10 (p = 0.008 and p = 0.04), with no significant differences in the remaining regions. These results suggest that Share 35 has been associated with transplanting “sicker patients” with higher MELD scores, and although no difference in survival is observed on a national level, outcomes appear to be concerning in some regions. |
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| Keywords: | clinical research/practice liver transplantation/hepatology organ allocation registry/registry analysis United Network for Organ Sharing (UNOS) |
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