Under Share-35, deceased donor (DD) livers are offered regionally to candidates with MELD≥35 before locally to lower MELD candidates. The characteristics and outcomes of local candidates, who would have been offered these livers first but were skipped under Share-35, have not been described.

Methods: We used SRTR data to study local candidates from June 18, 2013 to Feb 2, 2015 who had the highest allocation MELD (excluding Status 1A), for the longest time, and were ABO-identical or compatible to regional candidates transplanted at MELD≥35.

Results: 1,477 livers were regionally shared to MELD 35+ recipients with transplant MELD of median 39 (IQR 37-40). 1,351 (92%) skipped an ABO-identical local candidate, 121 (8%) skipped a compatible (but not identical) local candidate, and 5 (0.3%) had no active ABO-compatible local candidate at the time. There were 1035 individual candidates who were skipped at a median waitlist MELD of 31 (IQR 27-34), some of whom were skipped several times. 97 (9%) had a MELD score only 1 point less than the regional recipient. 244 (24%) had a comparable MELD (within 3 points of the regional recipient) and were listed a median of 3.4 (IQR 0.5-21) months when skipped for regional recipients listed 0.7 (IQR 0.2-5.2) months (p<0.001). Of these comparable candidates, 175 (72%) were eventually transplanted with a liver of median DRI 1.50 vs 1.37 of the skipping liver (p=0.3), 46 (19%) died or were removed for deteriorating condition, 15 (6%) remained waitlisted, and 8 (3%) were removed for other reasons. Of comparable candidates who were eventually transplanted, 88 (36%) were allocated locally, 32 (13%) regionally from the OPO they were skipped for, 54 (22%) regionally from another OPO in their region, and 1 nationally.

Conclusions: While 72% of locally-skipped comparable candidates were eventually transplanted, 19% died before transplantation. Modifications to Share-35 may be warranted to reduce potentially unnecessary regional swaps between comparable candidates.

CITATION INFORMATION: Chow E, Massie A, Luo X, Wickliffe C, Gentry S, Cameron A, Segev D. Skipping Comparable Local Waitlist Candidates Under Share 35. Am J Transplant. 2016;16 (suppl 3).

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