Background: The implementation of Share35 liver allocation policy in June 2013 facilitated the increase in number of transplanted livers with less organ discards. Early analysis demonstrated decreased waitlist mortality with no compromise to early post-transplant (postTXP) outcomes, including rates of 7-day retransplantation (reTXP) and early postTXP mortality. The impact of Share35 on early graft failure (EGF; loss of allograft at 7, 30, and 90 days postTXP from any cause) has yet to be examined.

Aim: To investigate the effect of Share35 policy on the incidence of EGF.

Method: A retrospective analysis was performed using UNOS database comparing the 2 years pre- and post-Share35. Basic recipient, donor, and perioperative characteristics were compared using student t-tests. Rates of EGF 7, 30, and 90 days post-transplantation were analyzed using Kaplan-Meier curves. Cox regression was used for identification of potential risk factors for EGF.

Results: In the pre- and post-Share35 era, we showed no significant difference between donor and recipient characteristics, although there was a trend toward higher average recipient MELD score, proportion on dialysis, and proportion in ICU at time of transplantation in post-Share35. Perioperative analyses demonstrated similar warm and cold ischemic times pre- and post-Share35 despite increased regional organ sharing. Analyses of graft survival at 7, 30, and 90 days postTXP revealed significantly increased rates of EGF in the post-Share35 era (2.08% vs 6.79%, 3.73% vs 16.39%, and 6.39% vs 23.25%, respectively, comparing pre- and post-Share35). Importantly, the higher EGF rate was seen in both the high MELD (MELD>35; 7.07% vs 16.57%) as well as the low MELD (MELD≤35; 3.98% vs 16.57%) recipients. Additionally, the overall time to graft loss was significantly shortened in post-Share35 (819.4 vs 262.46 days).

Conclusion: Although previous analyses have shown increased number of liver transplants with positive early outcomes with respect to waitlist mortality, 7-day reTXP rate, and early postTXP mortality after implementation of Share 35, the findings in our current study call for a potential need to reconsider the efficacy of this policy given the grossly increased rate of EGF and its possible long term consequences. Further analyses are warranted to identify specific donor, recipient, and peri-operative risk factors that may be responsible for the rise in EGF rate in the post-Share35 era.

CITATION INFORMATION: Wong T, Koizumi N, Ortiz J. Share35 Liver Allocation Is Associated with Increased Early Graft Failure Rate. Am J Transplant. 2016;16 (suppl 3).

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