A Annamalai1, W Ayoub2, V Sundaram2, A Klein2. 1. Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: alagappan.annamalai@cshs.org. 2. Cedars-Sinai Medical Center, Los Angeles, California.
Abstract
BACKGROUND: More than 10,000 patients are awaiting liver transplantation, and more than 1300 die waiting yearly. The Share 35 policy was implanted 1 year ago with expectations to decrease waitlist mortality. The purpose of our study was to look at waitlist outcomes and organ usage. METHODS: We compared data from the United Network of Organ Sharing before and after the initiation of Share 35, looking at waitlist mortality, organs shared with Model for End-Stage Liver Disease (MELD) score ≥ 35, organ discards, travel distance, cold ischemia time, MELD score at transplantation, donor characteristics, and waitlist times. The χ(2) test was used to compare the data from two time periods. RESULTS: Comparing the 1-year periods, we found no change in waitlist mortality rate; transplants in MELD score ≥ 35 increased from 19% to 27% and decreased in MELD score 15 to 34 from 74% to 67%; high-risk donors increased from 13% to 17%; and a 40% decrease in time on the waitlist before removal because of death from 58 to 35 days. CONCLUSIONS: One year since Share 35, there has been no change in waitlist mortality rate. Unfortunately, it will take several years to know the impact of Share 35 on changes in patient life-years saved.
BACKGROUND: More than 10,000 patients are awaiting liver transplantation, and more than 1300 die waiting yearly. The Share 35 policy was implanted 1 year ago with expectations to decrease waitlist mortality. The purpose of our study was to look at waitlist outcomes and organ usage. METHODS: We compared data from the United Network of Organ Sharing before and after the initiation of Share 35, looking at waitlist mortality, organs shared with Model for End-Stage Liver Disease (MELD) score ≥ 35, organ discards, travel distance, cold ischemia time, MELD score at transplantation, donor characteristics, and waitlist times. The χ(2) test was used to compare the data from two time periods. RESULTS: Comparing the 1-year periods, we found no change in waitlist mortality rate; transplants in MELD score ≥ 35 increased from 19% to 27% and decreased in MELD score 15 to 34 from 74% to 67%; high-risk donors increased from 13% to 17%; and a 40% decrease in time on the waitlist before removal because of death from 58 to 35 days. CONCLUSIONS: One year since Share 35, there has been no change in waitlist mortality rate. Unfortunately, it will take several years to know the impact of Share 35 on changes in patient life-years saved.
Authors: Douglas R Murken; Allison W Peng; David D Aufhauser; Peter L Abt; David S Goldberg; Matthew H Levine Journal: Liver Transpl Date: 2017-06 Impact factor: 5.799