title: Waitlist Outcomes of Liver Transplant Candidates Who Were Reprioritized Under Share 35.
abstract: Under Share 35, deceased donor (DD) livers are offered regionally to candidates with Model for End-Stage Liver Disease (MELD) scores ≥35 before being offered locally to candidates with MELD scores <35. Using Scientific Registry of Transplant Recipients data from June 2013 to June 2015, we identified 1768 DD livers exported to regional candidates with MELD scores ≥35 who were transplanted at a median MELD score of 39 (interquartile range [IQR] 37-40) with 30-day posttransplant survival of 96%. In total, 1764 (99.8%) exports had an ABO-compatible candidate in the recovering organ procurement organization (OPO), representing 1219 unique reprioritized candidates who would have had priority over the regional candidate under pre-Share 35 allocation. Reprioritized candidates had a median waitlist MELD score of 31 (IQR 27-34) when the liver was exported. Overall, 291 (24%) reprioritized candidates had a comparable MELD score (within 3 points of the regional recipient), and 209 (72%) were eventually transplanted in 11 days (IQR 3-38 days) using a local (50%), regional (50%) or national (<1%) liver; 60 (21%) died, 13 (4.5%) remained on the waitlist and nine (3.1%) were removed for other reasons. Of those eventually transplanted, MELD score did not increase in 57%; it increased by 1-3 points in 37% and by ≥4 points in 5.7% after the export. In three cases, OPOs exchanged regional exports within a 24-h window. The majority of comparable reprioritized candidates were not disadvantaged; however, 21% died after an export.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: E K H
authors.initials: EK
authors.lastname: Chow
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: A B
authors.initials: AB
authors.lastname: Massie
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: X
authors.initials: X
authors.lastname: Luo
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: C E
authors.initials: CE
authors.lastname: Wickliffe
authors.affiliation: Department of Mathematics, United States Naval Academy, Baltimore, MD.
authors.forename: S E
authors.identifier: http://orcid.org/0000-0003-4530-8917
authors.initials: SE
authors.lastname: Gentry
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: A M
authors.initials: AM
authors.lastname: Cameron
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: D L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017093:Liver Failure / Q000503:physiopathology / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000592:standards*; D011379:Prognosis; D012042:Registries; D012720:Severity of Illness Index; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement; D014850:Waiting Lists
keywords: epidemiology; health services and outcomes research; liver transplantation/hepatology; organ allocation; organ procurement and allocation