title: Liver transplantation after share 35: Impact on pretransplant and posttransplant costs and mortality.
abstract: Share 35 was implemented in 2013 to direct livers to the most urgent candidates by prioritizing Model for End-Stage Liver Disease (MELD) ≥ 35 patients. We aim to evaluate this policy's impact on costs and mortality. Our study includes 834 wait-listed patients and 338 patients who received deceased donor, solitary liver transplants at Mayo Clinic between January 2010 and December 2014. Of these patients, 101 (30%) underwent transplantation after Share 35. After Share 35, 29 (28.7%) MELD ≥ 35 patients received transplants, as opposed to 46 (19.4%) in the pre-Share 35 era (P = 0.06). No significant difference in 90-day wait-list mortality (P = 0.29) nor 365-day posttransplant mortality (P = 0.68) was found between patients transplanted before or after Share 35. Mean costs were $3,049 (P = 0.30), $5226 (P = 0.18), and $10,826 (P = 0.03) lower post-Share 35 for the 30-, 90-, and 365-day pretransplant periods, and mean costs were $5010 (P = 0.41) and $5859 (P = 0.57) higher, and $9145 (P = 0.54) lower post-Share 35 for the 30-, 90-, and 365-day posttransplant periods. In conclusion, the added cost of transplanting more MELD ≥ 35 patients may be offset by pretransplant care cost reduction. Despite shifting organs to critically ill patients, Share 35 has not impacted mortality significantly. Liver Transplantation 23:11-18 2017 AASLD.
authors.affiliation: William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN.
authors.forename: Clara T
authors.initials: CT
authors.lastname: Nicolas
authors.affiliation: William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN.|Division of General Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Nyberg
authors.affiliation: William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN.|Division of General Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Julie K
authors.initials: JK
authors.lastname: Heimbach
authors.affiliation: William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN.|Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
authors.forename: Kymberly
authors.initials: K
authors.lastname: Watt
authors.affiliation: Division of General Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Harvey S
authors.initials: HS
authors.lastname: Chen
authors.affiliation: Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Hathcock
authors.affiliation: William J. von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN.|Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
authors.forename: Walter K
authors.initials: WK
authors.lastname: Kremers
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D058625:End Stage Liver Disease / Q000191:economics / Q000401:mortality / Q000601:surgery*; D005260:Female; D017048:Health Care Costs; D005102:Health Expenditures; D006291:Health Policy / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000191:economics* / Q000331:legislation & jurisprudence*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000191:economics / Q000331:legislation & jurisprudence*; D016896:Treatment Outcome; D014481:United States; D014850:Waiting Lists / Q000401:mortality*