title: National Outcomes of Liver Transplantation for Model for End-Stage Liver Disease Score ≥40: The Impact of Share 35.
abstract: In certain regions of the United States in which organ donor shortages are persistent and competition is high, recipients wait longer and are critically ill with Model for End-Stage Liver Disease (MELD) scores ≥40 when they undergo liver transplantation. Recent implementation of Share 35 has increased the percentage of recipients transplanted at these higher MELD scores. The purpose of our study was to examine national data of liver transplant recipients with MELD scores ≥40 and to identify risk factors that affect graft and recipient survival. During the 12-year study period, 5002 adult recipients underwent deceased donor whole-liver transplantation. The 1-, 3-, 5- and 10-year graft survival rates were 77%, 69%, 64% and 50%, respectively. The 1-, 3-, 5- and 10-year patient survival rates were 80%, 72%, 67% and 53%, respectively. Multivariable analysis identified previous transplant, ventilator dependence, diabetes, hepatitis C virus, age >60 years and prolonged hospitalization prior to transplant as recipient factors increasing the risk of graft failure and death. Donor age >30 years was associated with an incrementally increased risk of graft failure and death. Recipients after implementation of Share 35 had shorter waiting times and higher graft and patient survival compared with pre-Share 35 recipients, demonstrating that some risk factors can be mitigated by policy changes that increase organ accessibility.
authors.affiliation: Department of Surgery, Keck School of Medicine of USC, Los Angeles, CA.
authors.forename: V
authors.initials: V
authors.lastname: Nekrasov
authors.affiliation: Department of Surgery, Keck School of Medicine of USC, Los Angeles, CA.
authors.forename: L
authors.initials: L
authors.lastname: Matsuoka
authors.affiliation: Department of Surgery, Keck School of Medicine of USC, Los Angeles, CA.
authors.forename: M
authors.initials: M
authors.lastname: Rauf
authors.affiliation: Department of Surgery, Keck School of Medicine of USC, Los Angeles, CA.
authors.forename: N
authors.initials: N
authors.lastname: Kaur
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA.
authors.forename: S
authors.initials: S
authors.lastname: Cao
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine of USC, Los Angeles, CA.
authors.forename: S
authors.initials: S
authors.lastname: Groshen
authors.affiliation: Department of Surgery, Keck School of Medicine of USC, Los Angeles, CA.
authors.forename: S P
authors.initials: SP
authors.lastname: Alexopoulos
mesh_terms: D000328:Adult; D000368:Aged; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D015996:Survival Rate; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014850:Waiting Lists
keywords: Organ Procurement and Transplantation Network (OPTN); classification systems: Model for Endstage Liver Disease (MELD); clinical decision-making; clinical research/practice; graft survival; health services and outcomes research; liver transplantation/hepatology; organ procurement and allocation; patient survival