Skip to main content
Journal cover image

One Size Does Not Fit All--Regional Variation in the Impact of the Share 35 Liver Allocation Policy.

Publication ,  Journal Article
Halazun, KJ; Mathur, AK; Rana, AA; Massie, AB; Mohan, S; Patzer, RE; Wedd, JP; Samstein, B; Subramanian, RM; Campos, BD; Knechtle, SJ
Published in: Am J Transplant
January 2016

Allocation policies for liver transplantation underwent significant changes in June 2013 with the introduction of Share 35. We aimed to examine the effect of Share 35 on regional variation in posttransplant outcomes. We examined two patient groups from the United Network for Organ Sharing dataset; a pre-Share 35 group composed of patients transplanted between June 17, 2012, and June 17, 2013 (n = 5523), and a post-Share group composed of patients transplanted between June 18, 2013, and June 18, 2014 (n = 5815). We used Kaplan-Meier and Cox multivariable analyses to compare survival. There were significant increases in allocation Model for End-stage Liver Disease (MELD) scores, laboratory MELD scores, and proportions of patients in the intensive care unit and on mechanical, ventilated, or organ-perfusion support at transplant post-Share 35. We also observed a significant increase in donor risk index in this group. We found no difference on a national level in survival between patients transplanted pre-Share 35 and post-Share 35 (p = 0.987). Regionally, however, posttransplantation survival was significantly worse in the post-Share 35 patients in regions 4 and 10 (p = 0.008 and p = 0.04), with no significant differences in the remaining regions. These results suggest that Share 35 has been associated with transplanting "sicker patients" with higher MELD scores, and although no difference in survival is observed on a national level, outcomes appear to be concerning in some regions.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Am J Transplant

DOI

EISSN

1600-6143

Publication Date

January 2016

Volume

16

Issue

1

Start / End Page

137 / 142

Location

United States

Related Subject Headings

  • Waiting Lists
  • Tissue and Organ Procurement
  • Tissue Donors
  • Surgery
  • Resource Allocation
  • Practice Guidelines as Topic
  • Policy Making
  • Middle Aged
  • Male
  • Liver Transplantation
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Halazun, K. J., Mathur, A. K., Rana, A. A., Massie, A. B., Mohan, S., Patzer, R. E., … Knechtle, S. J. (2016). One Size Does Not Fit All--Regional Variation in the Impact of the Share 35 Liver Allocation Policy. Am J Transplant, 16(1), 137–142. https://doi.org/10.1111/ajt.13500
Halazun, K. J., A. K. Mathur, A. A. Rana, A. B. Massie, S. Mohan, R. E. Patzer, J. P. Wedd, et al. “One Size Does Not Fit All--Regional Variation in the Impact of the Share 35 Liver Allocation Policy.Am J Transplant 16, no. 1 (January 2016): 137–42. https://doi.org/10.1111/ajt.13500.
Halazun KJ, Mathur AK, Rana AA, Massie AB, Mohan S, Patzer RE, et al. One Size Does Not Fit All--Regional Variation in the Impact of the Share 35 Liver Allocation Policy. Am J Transplant. 2016 Jan;16(1):137–42.
Halazun, K. J., et al. “One Size Does Not Fit All--Regional Variation in the Impact of the Share 35 Liver Allocation Policy.Am J Transplant, vol. 16, no. 1, Jan. 2016, pp. 137–42. Pubmed, doi:10.1111/ajt.13500.
Halazun KJ, Mathur AK, Rana AA, Massie AB, Mohan S, Patzer RE, Wedd JP, Samstein B, Subramanian RM, Campos BD, Knechtle SJ. One Size Does Not Fit All--Regional Variation in the Impact of the Share 35 Liver Allocation Policy. Am J Transplant. 2016 Jan;16(1):137–142.
Journal cover image

Published In

Am J Transplant

DOI

EISSN

1600-6143

Publication Date

January 2016

Volume

16

Issue

1

Start / End Page

137 / 142

Location

United States

Related Subject Headings

  • Waiting Lists
  • Tissue and Organ Procurement
  • Tissue Donors
  • Surgery
  • Resource Allocation
  • Practice Guidelines as Topic
  • Policy Making
  • Middle Aged
  • Male
  • Liver Transplantation