Given increased sharing under Share35, we investigated whether Share35 reduced geographic disparity in deceased-donor liver transplant (DDLT) rates across Donation Service Areas (DSAs).

METHODS: Using SRTR data 6/2010-6/2016, we identified 93,610 adult liver transplant candidates and estimated MELD-adjusted DDLT rates using multilevel Poisson regression. From this model, we derived the incidence rate ratio (IRR) of DDLT rates between each pair of DSAs and the median of the IRRs (MIRR). MIRR is derived from the variation in DDLT rates across DSAs and represents an overall measure of geographic disparity. Larger MIRR indicates greater disparity.

RESULTS: After Share35, MIRR was 2.28. In other words, two candidates with the same MELD in different DSAs were expected to have a 2.28-fold difference in DDLT rate post-Share35. Comparing MIRR to the impact of MELD on DDLT rate, post-Share35 an increase in MELD from 22-24 to 25-28 was associated with 2.32-fold higher rate of DDLT (Table1B, Column 2), an increase from 38-40 to Status 1 was associated with 1.67-fold higher rate, while relisting in a different DSA could increase a candidate's rate of DDLT by 2.28-fold. MIRR remained almost unchanged with increased sharing, at 2.25 pre-Share35 and 2.28 post-Share35.

CONCLUSION: Share 35 did not decrease geographic disparity in DDLT rate. After Share 35, geographic location remains a major determinant of access to DDLT.

CITATION INFORMATION: Bowring M., Chow E., Massie A., Segev D., Gentry S. Changes in Geographic Disparity Following Share 35 Am J Transplant. 2017;17 (suppl 3).

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