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Same Policy, Different Impact: Center and Regional Effects of SHARE 35 Liver Allocation.

D. Murken,1 A. Peng,1 D. Aufhauser Jr,1 D. Goldberg,2 M. Levine.1

1Surgery, University of Pennsylvania, Philadelphia, PA
2Medicine, University of Pennsylvania, Philadelphia, PA.

Meeting: 2016 American Transplant Congress

Abstract number: B241

Keywords: Allocation, Liver transplantation

Session Information

Session Name: Poster Session B: Liver: MELD, Allocation and Donor Issues (DCD/ECD)

Session Type: Poster Session

Date: Sunday, June 12, 2016

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

Introduction: Early studies of national data suggest that Share-35 implementation was associated with more liver transplants, fewer discards, and lower waitlist mortality, without worsening of post-transplant outcomes. Patterns of utilization of Share-35 at a regional and center specific level remain unknown.

Methods: United Network for Organ Sharing data was analyzed to compare liver transplant recipients with allocation-MELD (aMELD) ≥35 from the two years prior and the one year after Share-35 implementation.

Results: Analysis revealed among-center variation in the number and proportion of aMELD ≥35 transplants pre- versus post-Share-35. While most centers saw minimal volume changes, there were nine centers with a ≥15 increase in aMELD ≥35 transplants the year after implementation (Figure 1). The top 10 centers, determined by the largest increase in aMELD ≥35 transplants from the year before to the year after Share-35, accounted for 66.1% of the total national increase in aMELD ≥35 transplants. Day of transplant true lab MELD scores for patients transplanted with aMELD ≥ 35 were compared pre- versus post-Share-35. In most regions, the percent of patients who had a true lab MELD ≥35 on their day of transplant decreased (Figure 2), and nationally, the percentage of patients decreased from 67.8% pre- to 66.4% post-Share 35.

Conclusion: There was significant variation in the volume changes of aMELD ≥35 transplants between centers, with the majority of the increase in volume attributable to a few centers. Longer term data is needed to assess whether the outcome for patients in centers with large volume increases are equivalent to other aMELD ≥35 patients, and what factors in listing, organ access, or center aggressiveness are contributing to these differences.

CITATION INFORMATION: Murken D, Peng A, Aufhauser Jr D, Goldberg D, Levine M. Same Policy, Different Impact: Center and Regional Effects of SHARE 35 Liver Allocation. Am J Transplant. 2016;16 (suppl 3).

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To cite this abstract in AMA style:

Murken D, Peng A, Jr DAufhauser, Goldberg D, Levine M. Same Policy, Different Impact: Center and Regional Effects of SHARE 35 Liver Allocation. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/same-policy-different-impact-center-and-regional-effects-of-share-35-liver-allocation/. Accessed May 31, 2025.

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