title: Early changes in liver distribution following implementation of Share 35.
abstract: In June 2013, a change to the liver waitlist priority algorithm was implemented. Under Share 35, regional candidates with MELD ≥ 35 receive higher priority than local candidates with MELD < 35. We compared liver distribution and mortality in the first 12 months of Share 35 to an equivalent time period before. Under Share 35, new listings with MELD ≥ 35 increased slightly from 752 (9.2% of listings) to 820 (9.7%, p = 0.3), but the proportion of deceased-donor liver transplants (DDLTs) allocated to recipients with MELD ≥ 35 increased from 23.1% to 30.1% (p < 0.001). The proportion of regional shares increased from 18.9% to 30.4% (p < 0.001). Sharing of exports was less clustered among a handful of centers (Gini coefficient decreased from 0.49 to 0.34), but there was no evidence of change in CIT (p = 0.8). Total adult DDLT volume increased from 4133 to 4369, and adjusted odds of discard decreased by 14% (p = 0.03). Waitlist mortality decreased by 30% among patients with baseline MELD > 30 (SHR = 0.70, p < 0.001) with no change for patients with lower baseline MELD (p = 0.9). Posttransplant length-of-stay (p = 0.2) and posttransplant mortality (p = 0.9) remained unchanged. In the first 12 months, Share 35 was associated with more transplants, fewer discards, and lower waitlist mortality, but not at the expense of CIT or early posttransplant outcomes.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD.
authors.forename: A B
authors.initials: AB
authors.lastname: Massie
authors.forename: E K H
authors.initials: EK
authors.lastname: Chow
authors.forename: C E
authors.initials: CE
authors.lastname: Wickliffe
authors.forename: X
authors.initials: X
authors.lastname: Luo
authors.forename: S E
authors.initials: SE
authors.lastname: Gentry
authors.forename: D C
authors.initials: DC
authors.lastname: Mulligan
authors.forename: D L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D006801:Humans; D016031:Liver Transplantation; D014481:United States; D014850:Waiting Lists
keywords: United Network for Organ Sharing (UNOS); epidemiology; ethics and public policy; health services and outcomes research; liver transplantation/hepatology; organ allocation; organ procurement and allocation; social sciences