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Waitlist Outcomes of Liver Transplant Candidates Who Were Reprioritized Under Share 35
Author(s) -
Chow E. K. H.,
Massie A. B.,
Luo X.,
Wickliffe C. E.,
Gentry S. E.,
Cameron A. M.,
Segev D. L.
Publication year - 2017
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.13980
Subject(s) - medicine , interquartile range , liver disease , liver transplantation , model for end stage liver disease , organ procurement , transplantation , surgery
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, OPO s exchanged regional exports within a 24‐h window. The majority of comparable reprioritized candidates were not disadvantaged; however, 21% died after an export.