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Liver Transplantation Outcomes after Share 35: Analysis of NASH Recipients from UNOS Database

Y. Zhang,1 M. Boktour.2

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

Related Abstracts
  • Racial Disparities in Post-Liver Transplant Survival before and after Share 35 Implementation
  • Assessing the Impact of the Share35 Liver Allocation Policy: Survival Outcomes Among Liver Re-Transplant Recipients.

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 35Post-Share 35
Graft survival
All patients83.781.61.08 (0.91, 1.29)1.00 (0.84, 1.20)
MELD >= 3580.373.31.30 (0.89, 1.89)1.20 (0.82, 1.77)
MELD < 3584.383.90.99 (0.81, 1.20)0.94 (0.77, 1.14)
Patient survival
All patients85.682.41.15 (0.95, 1.38)1.04 (0.86, 1.26)
MELD >= 3581.073.91.31 (0.90, 1.91)1.21 (0.82, 1.78)
MELD < 3586.585.31.03 (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).

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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.

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