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Same policy, different impact: Center‐level effects of share 35 liver allocation
Author(s) -
Murken Douglas R.,
Peng Allison W.,
Aufhauser David D.,
Abt Peter L.,
Goldberg David S.,
Levine Matthew H.
Publication year - 2017
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.24769
Subject(s) - united network for organ sharing , medicine , liver transplantation , listing (finance) , liver disease , demography , surgery , transplantation , finance , business , sociology
Early studies of national data suggest that the Share 35 allocation policy increased liver transplants without compromising posttransplant outcomes. Changes in center‐specific volumes and practice patterns in response to the national policy change are not well characterized. Understanding center‐level responses to Share 35 is crucial for optimizing the policy and constructing effective future policy revisions. Data from the United Network for Organ Sharing were analyzed to compare center‐level volumes of allocation–Model for End‐Stage Liver Disease (aMELD) ≥ 35 transplants before and after policy implementation. There was significant center‐level variation in the number and proportion of aMELD ≥ 35 transplants performed from the pre– to post–Share 35 period; 8 centers accounted for 33.7% of the total national increase in aMELD ≥ 35 transplants performed in the 2.5‐year post–Share 35 period, whereas 25 centers accounted for 65.0% of the national increase. This trend correlated with increased listing at these centers of patients with Model for End‐Stage Liver Disease (MELD) ≥ 35 at the time of initial listing. These centers did not overrepresent the total national volume of liver transplants. Comparison of post–Share 35 aMELD to calculated time‐of‐transplant (TOT) laboratory MELD scores showed that only 69.6% of patients transplanted with aMELD ≥ 35 maintained a calculated laboratory MELD ≥ 35 at the TOT. In conclusion, Share 35 increased transplantation of aMELD ≥ 35 recipients on a national level, but the policy asymmetrically impacted practice patterns and volumes of a subset of centers. Longer‐term data are necessary to assess outcomes at centers with markedly increased volumes of high‐MELD transplants after Share 35. Liver Transplantation 23 741–750 2017 AASLD .