Introduction. On June 18, 2013, the OPTN implemented regional sharing of adult donor livers for candidates with allocation MELD/PELD scores of 35 and greater. As part of this policy, after offers to Status 1A/1B candidates, adult donor livers are offered nationally to candidates awaiting a liver and intestine before being offered to local MELD/PELD candidates with scores of 29 and greater. We analyzed the impact of this policy on liver-intestine candidates.

Methods. To assess the impact of the policy, we calculated transplant rates and mortality rates in two eras for both adult and pediatric candidates. The pre-era included listings from 6/18/2011 – 6/17/2013. The post-era included listings from 6/18/2013 – 6/18/2015. Each era consisted of 730 days, and the “at risk” period for each candidate was truncated at the end of each era where necessary. A competing risks analysis was performed to estimate the probability of transplant and the probability of death within 12 months of being listed simultaneously for both the liver and the intestine. Candidates removed for “too sick” were counted as deaths.

Results. More candidates were simultaneously listed for a liver-intestine in the post-era (310 vs 272), and there were more liver-intestine transplants in the post-era (154 vs 83). Transplants were performed at 17 centers in the pre-era, and at 16 centers in the post-era. The most common diagnosis at transplant in the post-era was short gut syndrome (62%), which occurred proportionally less often than in the pre-era (67%). More adult (49.3% vs 31.3%) and Hispanic (23.4% vs 10.8%) recipients were transplanted in the post-era. The distribution of gender was unchanged. The probability of a liver-intestine transplant within 12 months was significantly greater in the post-era (46% vs 30%, p < 0.05). The probability of death within 12 months was slightly lower in the post-era (11% vs 12%) but did not reach statistical significance.

Conclusion. Although the policy resulted in a substantial increase in liver-intestine transplants, the death rate was essentially unchanged. This could be due to the increase in demand for liver-intestines in the post-era and perhaps changes in patient selection for transplant. The OPTN will continue to monitor the outcomes of these patients in the future.

CITATION INFORMATION: Edwards E, Harper A, Sudan D. Liver-Intestine Candidates Benefit from National Sharing. Am J Transplant. 2016;16 (suppl 3).

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