The Share 35 policy was implemented in June 2013 to improve equity in access to liver transplantation (LT) between patients with fulminant liver failure and those with cirrhosis and severe hepatic decompensation. The aim of this study was to assess post-LT outcomes after Share 35. Relevant donor, procurement, and recipient data were extracted from the Organ Procurement and Transplantation Network/United Network for Organ Sharing database. All adult deceased donor LTs from January 1, 2010, to March 31, 2016, were included in the analysis. One-year patient survival before and after Share 35 was assessed by multivariable Cox proportional hazards analysis, with adjustment for variables known to affect graft survival. Of 34,975 adult LT recipients, 16,472 (47.1%) were transplanted after the implementation of Share 35, of whom 4,599 (27.9%) had a Model for End-Stage Liver Disease (MELD) score ≥35. One-year patient survival improved from 83.9% to 88.4% after Share 35 (P < 0.01) for patients with MELD ≥35. There was no significant impact on survival of patients with MELD <35 (P = 0.69). Quality of donor organs, as measured by a donor risk index without the regional share component, improved for patients with MELD ≥35 (P < 0.01) and worsened for patients with lower MELD (P < 0.01). In multivariable Cox regression analysis, Share 35 was associated with improved 1-year patient survival (hazard ratio, 0.69; 95% confidence interval, 0.60-0.80) in recipients with MELD ≥35. CONCLUSION: Share 35 has had a positive impact on survival after transplantation in patients with MELD ≥35, without a reciprocal detriment in patients with lower acuity; this was in part a result of more favorable donor-recipient matching. (Hepatology 2018;67:273-281).
The Share 35 policy was implemented in June 2013 to improve equity in access to liver transplantation (LT) between patients with fulminant liver failure and those with cirrhosis and severe hepatic decompensation. The aim of this study was to assess post-LT outcomes after Share 35. Relevant donor, procurement, and recipient data were extracted from the Organ Procurement and Transplantation Network/United Network for Organ Sharing database. All adult deceased donor LTs from January 1, 2010, to March 31, 2016, were included in the analysis. One-year patient survival before and after Share 35 was assessed by multivariable Cox proportional hazards analysis, with adjustment for variables known to affect graft survival. Of 34,975 adult LT recipients, 16,472 (47.1%) were transplanted after the implementation of Share 35, of whom 4,599 (27.9%) had a Model for End-Stage Liver Disease (MELD) score ≥35. One-year patient survival improved from 83.9% to 88.4% after Share 35 (P < 0.01) for patients with MELD ≥35. There was no significant impact on survival of patients with MELD <35 (P = 0.69). Quality of donor organs, as measured by a donor risk index without the regional share component, improved for patients with MELD ≥35 (P < 0.01) and worsened for patients with lower MELD (P < 0.01). In multivariable Cox regression analysis, Share 35 was associated with improved 1-year patient survival (hazard ratio, 0.69; 95% confidence interval, 0.60-0.80) in recipients with MELD ≥35. CONCLUSION: Share 35 has had a positive impact on survival after transplantation in patients with MELD ≥35, without a reciprocal detriment in patients with lower acuity; this was in part a result of more favorable donor-recipient matching. (Hepatology 2018;67:273-281).
Authors: B Nemes; F Gelley; G Zádori; L Piros; J Perneczky; L Kóbori; I Fehérvári; D Görög Journal: Transplant Proc Date: 2010 Jul-Aug Impact factor: 1.066
Authors: P S Kamath; R H Wiesner; M Malinchoc; W Kremers; T M Therneau; C L Kosberg; G D'Amico; E R Dickson; W R Kim Journal: Hepatology Date: 2001-02 Impact factor: 17.425
Authors: E K H Chow; A B Massie; X Luo; C E Wickliffe; S E Gentry; A M Cameron; D L Segev Journal: Am J Transplant Date: 2016-08-24 Impact factor: 8.086
Authors: Clara T Nicolas; Scott L Nyberg; Julie K Heimbach; Kymberly Watt; Harvey S Chen; Matthew A Hathcock; Walter K Kremers Journal: Liver Transpl Date: 2016-12-05 Impact factor: 5.799
Authors: Michał Grąt; Karolina M Wronka; Waldemar Patkowski; Jan Stypułkowski; Karolina Grąt; Maciej Krasnodębski; Łukasz Masior; Zbigniew Lewandowski; Marek Krawczyk Journal: Dig Dis Sci Date: 2016-02 Impact factor: 3.199
Authors: Georg P Györi; David Pereyra; Benedikt Rumpf; Hubert Hackl; Christoph Köditz; Gregor Ortmayr; Thomas Reiberger; Michael Trauner; Gabriela A Berlakovich; Patrick Starlinger Journal: Hepatology Date: 2020-04-23 Impact factor: 17.425
Authors: Patrick Starlinger; Joseph C Ahn; Aidan Mullan; Georg P Gyoeri; David Pereyra; Roberto Alva-Ruiz; Hubert Hackl; Thomas Reiberger; Michael Trauner; Jonas Santol; Benedikt Simbrunner; Mattias Mandorfer; Gabriela Berlakovich; Patrick S Kamath; Julie Heimbach Journal: Hepatology Date: 2021-08-29 Impact factor: 17.425
Authors: Hillary J Braun; Jennifer L Dodge; Joshua D Grab; Marisa E Schwab; Iris H Liu; Alexa C Glencer; Peter G Stock; Ryutaro Hirose; John P Roberts; Nancy L Ascher Journal: Transplantation Date: 2021-04-01 Impact factor: 5.385