Liver Transplantation Outcomes after Share 35: Analysis of NASH Recipients from UNOS Database
1Department of Biostatistics, University of Texas Health Science Center, Houston, TX
2Department of Surgery, Methodist Hospital, Houston, TX.
Meeting: 2018 American Transplant Congress
Abstract number: 576
Keywords: Graft survival, Liver transplantation, Survival
Session Information
Date: Tuesday, June 5, 2018
Session Name: Concurrent Session: Non-Organ Specific: Economics, Public Policy, Allocation, Ethics - 3
Session Time: 4:30pm-6:00pm
Presentation Time: 5:30pm-5:42pm
Location: Room 4C-4
Background: Non-alcoholic steatohepatitis (NASH) is a rapidly growing indication for liver transplantation (LT) among patients with end-stage liver diseases. The study aimed to examine the LT outcomes in NASH recipients particularly in recipients with a biological MELD score of 35 or higher after the implementation of Share 35 policy.
Methods: A retrospective analysis was performed in 4,380 adult patients from the UNOS database who received deceased donor LT between 2009 and 2017 due to primary diagnosis of NASH or cryptogenic cirrhosis with body mass index ≥ 30. Cox regressions were used to model the effect of the share 35 policy on post-LT graft and patient survivals comparing the first 3 years of Share 35 to an equivalent time period before. Stratification on MELD score of 35 or higher was performed.
Results: The number of NASH patients received LT increased from 232 (14.1%) in 2009 to 266 (20.5%) in 2017. Compared to pre-Share 35 era, average MELD score was higher (26.5 vs 24.7) with a higher proportion of recipients having MELD ≥ 35 (22.9% vs 15.5%), mean waitlist time decreased from 219.3 days to 137.5 days, and average cold ischemic time decreased from 6.4 hours to 6 hours. However, no significant differences was found in the average length of hospitalization after LT. Three-year graft and patient survivals were comparable either in the entire cohort or within recipients having MELD ≥ 35.
| 3-year survival (%) | Unadjusted HR (95% CI) | Adjusted HR (95% CI) | ||
| Pre-Share 35 | Post-Share 35 | |||
| Graft survival | ||||
| All patients | 83.7 | 81.6 | 1.08 (0.91, 1.29) | 1.00 (0.84, 1.20) |
| MELD >= 35 | 80.3 | 73.3 | 1.30 (0.89, 1.89) | 1.20 (0.82, 1.77) |
| MELD < 35 | 84.3 | 83.9 | 0.99 (0.81, 1.20) | 0.94 (0.77, 1.14) |
| Patient survival | ||||
| All patients | 85.6 | 82.4 | 1.15 (0.95, 1.38) | 1.04 (0.86, 1.26) |
| MELD >= 35 | 81.0 | 73.9 | 1.31 (0.90, 1.91) | 1.21 (0.82, 1.78) |
| MELD < 35 | 86.5 | 85.3 | 1.03 (0.83, 1.28) | 0.97 (0.78, 1.21) |
Conclusion: Share 35 policy benefits NASH patients from reduced waitlist time before LT without increasing cold ischemic time or length of hospitalization. Share 35 is also associated with comparable outcomes particularly in desperate patients with MELD score ≥ 35.
CITATION INFORMATION: Zhang Y., Boktour M. Liver Transplantation Outcomes after Share 35: Analysis of NASH Recipients from UNOS Database Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Zhang Y, Boktour M. Liver Transplantation Outcomes after Share 35: Analysis of NASH Recipients from UNOS Database [abstract]. https://atcmeetingabstracts.com/abstract/liver-transplantation-outcomes-after-share-35-analysis-of-nash-recipients-from-unos-database/. Accessed December 14, 2019.« Back to 2018 American Transplant Congress