TY - JOUR
T1 - Geographic variation in liver transplantation persists despite implementation of Share35
AU - Stine, Jonathan G.
AU - Northup, Patrick G.
AU - Stukenborg, George J.
AU - Cornella, Scott L.
AU - Maluf, Daniel G.
AU - Pelletier, Shawn J.
AU - Argo, Curtis K.
N1 - Funding Information:
Correspondence: Dr Jonathan G. Stine, Division of Gastroenterology and Hepatology, Milton S. Hershey Medical Center, The Pennsylvania State University, 200 Campus Drive, Entrance 4, Suite 2400 Hershey, PA 17033, USA. Email: jstine@pennstatehealth.psu.edu Conflict of interest: The authors have no conflict of interest. Financial support: Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number 5T32DK007769-15. This work was presented in abstract form at the 2015 Digestive Disease Week (AASLD) Washington, DC as a Poster of Distinction. Received 31 March 2017; revision 12 May 2017; accepted 6 June 2017.
Publisher Copyright:
© 2017 The Japan Society of Hepatology
PY - 2018/3
Y1 - 2018/3
N2 - Aim: Geographic disparities persist in the USA despite locoregional organ sharing policies. The impact of national organ sharing policies on waiting-list mortality on a regional basis remains unknown. Methods: Data on all adult liver transplants between 1 February 2002 and 31 March 2015 were obtained from the United Network for Organ Sharing/Organ and Transplantation Network. Multivariable Cox proportional hazards models were constructed in a time-to-event analysis to estimate waiting-list mortality for the pre- and post-Share35 eras. Results: In the analyzed time period, 134 247 patients were listed for transplantation and 54 510 received organs (42.8%). Listing volume increased following the introduction of the Share35 organ sharing policy (15 976 candidates pre- vs. 18 375 post) without significant regional changes as did the number of transplants (7210 pre- vs. 8224 post). Waiting-list mortality improved from 12.2% to 8.1% (P < 0.001). Adjusted waiting-list mortality ratios remained geographically disparate. Region 10 and region 11 had lower hazard ratios (HR) but still had increased mortality (1.46, 95% confidence interval [CI] 1.34–1.60, P < 0.001; and HR 1.49, 95% CI 1.37–1.62, P < 0.001, respectively). Regions 3 and 6 had increased HR with persistently elevated waiting-list mortality (1.79, 95% CI 1.66–1.93, P < 0.001; and HR 1.29, 95% CI 1.16–1.45, P < 0.001, respectively). Model for End-state Liver Disease (MELD) exception continued to propagate a survival benefit (HR 0.65, 95% CI 0.63–0.68, P < 0.001). Conclusions: Although overall waiting-list mortality has decreased, geographic disparities persist, but appear reduced despite broader sharing policies enacted by Share35. The advantage afforded by MELD exception, while still present, was diminished by Share35 as organs are being shifted to MELD >35 candidates. The disparities highlighted by our findings imply a need to review current allocation policies to best balance local, regional, and national transplant environments.
AB - Aim: Geographic disparities persist in the USA despite locoregional organ sharing policies. The impact of national organ sharing policies on waiting-list mortality on a regional basis remains unknown. Methods: Data on all adult liver transplants between 1 February 2002 and 31 March 2015 were obtained from the United Network for Organ Sharing/Organ and Transplantation Network. Multivariable Cox proportional hazards models were constructed in a time-to-event analysis to estimate waiting-list mortality for the pre- and post-Share35 eras. Results: In the analyzed time period, 134 247 patients were listed for transplantation and 54 510 received organs (42.8%). Listing volume increased following the introduction of the Share35 organ sharing policy (15 976 candidates pre- vs. 18 375 post) without significant regional changes as did the number of transplants (7210 pre- vs. 8224 post). Waiting-list mortality improved from 12.2% to 8.1% (P < 0.001). Adjusted waiting-list mortality ratios remained geographically disparate. Region 10 and region 11 had lower hazard ratios (HR) but still had increased mortality (1.46, 95% confidence interval [CI] 1.34–1.60, P < 0.001; and HR 1.49, 95% CI 1.37–1.62, P < 0.001, respectively). Regions 3 and 6 had increased HR with persistently elevated waiting-list mortality (1.79, 95% CI 1.66–1.93, P < 0.001; and HR 1.29, 95% CI 1.16–1.45, P < 0.001, respectively). Model for End-state Liver Disease (MELD) exception continued to propagate a survival benefit (HR 0.65, 95% CI 0.63–0.68, P < 0.001). Conclusions: Although overall waiting-list mortality has decreased, geographic disparities persist, but appear reduced despite broader sharing policies enacted by Share35. The advantage afforded by MELD exception, while still present, was diminished by Share35 as organs are being shifted to MELD >35 candidates. The disparities highlighted by our findings imply a need to review current allocation policies to best balance local, regional, and national transplant environments.
UR - http://www.scopus.com/inward/record.url?scp=85042685932&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85042685932&partnerID=8YFLogxK
U2 - 10.1111/hepr.12922
DO - 10.1111/hepr.12922
M3 - Article
C2 - 28603899
AN - SCOPUS:85042685932
VL - 48
SP - 225
EP - 232
JO - Hepatology Research
JF - Hepatology Research
SN - 1386-6346
IS - 4
ER -
