A Share 21 model in liver transplantation: Impact on waitlist outcomes. Issue 8 (5th April 2020)

• Record Type: Journal Article
• Authors: Nagai, Shunji; Chau, Lucy C.; Kitajima, Toshihiro; Yeddula, Sirisha; Collins, Kelly; Rizzari, Michael; Yoshida, Atsushi; Abouljoud, Marwan S.; Moonka, Dilip
• Is Part Of: American journal of transplantation. Volume 20:Issue 8(2020)
• Page Start: 2184
• Page End: 2197
• Publication Date: 2020-04-05
• Subjects: clinical research/practice -- donors and donation: deceased -- liver disease -- liver transplantation/hepatology -- organ procurement and allocation -- Organ Procurement and Transplantation Network (OPTN) -- United Network for Organ Sharing (UNOS) -- waitlist management; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.15836
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : With the introduction of Model for End‐Stage Liver Disease‐Sodium (MELD‐Na)–based allocation, the score at which patients benefit from liver transplantation (LT) has shifted from a score of 15 to 21. This study aimed to evaluate waitlist outcomes in patients with MELD‐Na scores <21 and explore the utility of replacing "Share 15" with "Share 21." The study uses data from the Organ Procurement and Transplantation Network/United Network for Organ Sharing registry. All adult patients registered for LT after implementation of the MELD‐Na–based allocation were evaluated. Waitlist patients with initial and final scores <21 were eligible. Patients with exception scores were excluded. To explore the potential impact of a Share 21 model, patients with an initial MELD‐Na score of 6‐14 (Group 1) and those with a score of 15‐20 (Group 2) were compared for waitlist outcomes. There were 3686 patients with an initial score of 6‐14 (Group 1) and 3282 with a score of 15‐20 (Group 2). Group 2, when compared to Group 1, showed comparable risk of mortality (adjusted hazard ratio [aHR] 1.00, P = .97), higher transplant probability (aHR 3.25, P < .001), and lower likelihood of removal from listing because of improvement (aHR 0.74, P = .011). Share 21 may enhance transplant opportunities and increase parity for patients with higher MELD‐Na scores without compromising waitlist outcomes. Abstract : Share 21 may enhance transplant opportunities and increase parity for patients with higher MELD‐Na scores without compromising waitlist outcomes in patients with lower MELD‐Na scores.