Introduction. The OPTN implemented full regional sharing of adult donor livers for all Status 1A and Status 1B liver candidates on December 15, 2010. Prior to that date, livers in most regions were offered sequentially to Status 1 candidates first locally, then regionally. As part of its ongoing monitoring of the allocation system, the OPTN Liver and Intestinal Organ Transplantation Committee recently assessed the impact of this policy on pre-transplant outcomes.

Methods. An intent-to-treat analysis was performed of all candidates entering Status 1A or Status 1B during a pre-implementation period (Era 1: 10/15/09 – 12/14/10) and a post-implementation period (Era 2: 12/15/10 – 2/14/2012). The cumulative incidence of waiting list outcomes was estimated from competing risks probabilities.

Results. Compared to Era 1, there were 55 fewer adult candidates entering Status 1 in Era 2 but 15 more pediatric candidates. Ethnicity on the waiting list was similar between eras for the Status 1As, but proportionally there were fewer Whites and Hispanics in Status 1B during Era 2. Overall, there were 41 fewer Status 1 transplant recipients in Era 2, but among Status 1As there were more non-white recipients. Ethnicity among Status 1B recipients was similar in both eras. Overall, the transplant rate within 90 days of listing was higher and the waiting list death rate was lower for Status 1 candidates in Era 2. Death rates in each era are shown in Table 1.

Conclusions. Implementation of full regional sharing has benefitted both adult and pediatric Status 1 candidates, with a decreased waiting list death rate. In particular, pediatric candidates with chronic liver disease received the most benefit.

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