title: Effects of the Share 35 Rule on Waitlist and Liver Transplantation Outcomes for Patients with Hepatocellular Carcinoma.
abstract: BACKGROUND
  Several studies have investigated the effects following the implementation of the "Share 35" policy; however none have investigated what effect this policy change has had on waitlist and liver transplantation (LT) outcomes for hepatocellular carcinoma(HCC).
  
  
  METHODS
  Data were obtained from the UNOS database and a comparison of the 2 years post-Share 35 with data from the 2 years pre-Share 35 was performed.
  
  
  RESULTS
  In the pre-Share35 era, 23% of LT were performed for HCC exceptions compared to 22% of LT in the post-Share35 era (p = 0.21). No difference in wait-time for HCC patients was seen in any of the UNOS regions between the 2 eras. Competing risk analysis demonstrated that HCC candidates in post-Share 35 era were more likely to die or be delisted for "too sick" while waiting (7.2% vs. 5.3%; p = 0.005) within 15 months. A higher proportion of ECD (p<0.001) and DCD (p<0.001) livers were used for patients transplanted for HCC, while lower DRI organs were used for those patients transplanted with a MELD≥35 between the 2 eras (p = 0.007).
  
  
  CONCLUSIONS
  No significant change to wait-time for patients listed for HCC was seen following implementation of "Share 35". Transplant program behavior has changed resulting use of higher proportion of ECD and DCD liver grafts for patients with HCC. A higher rate of wait list mortality was observed in patients with HCC in the post-Share 35 era.
authors.affiliation: Department of Transplant, Mayo Clinic Florida, Jacksonville, Florida.
authors.forename: Kristopher P
authors.initials: KP
authors.lastname: Croome
authors.affiliation: Department of Transplant, Mayo Clinic Florida, Jacksonville, Florida.
authors.forename: David D
authors.initials: DD
authors.lastname: Lee
authors.affiliation: Department of Transplant, Mayo Clinic Florida, Jacksonville, Florida.
authors.forename: Denise
authors.initials: D
authors.lastname: Harnois
authors.affiliation: Department of Transplant, Mayo Clinic Florida, Jacksonville, Florida.
authors.forename: C Burcin
authors.initials: CB
authors.lastname: Taner
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D058625:End Stage Liver Disease / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation; D018579:Patient Selection; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014850:Waiting Lists