Liver

Area of Science:

• Hepatology and Transplant Surgery
• Public Health Policy and Outcomes Research

Background:

• Liver transplantation is a critical treatment for end-stage liver disease.
• Organ allocation policies significantly impact patient access and outcomes.
• The Share 35 policy aimed to improve equity and efficiency in liver allocation.

Purpose of the Study:

• To evaluate the impact of the Share 35 policy on liver transplant waiting times and mortality.
• To analyze trends in the pediatric liver transplant waiting list and transplant volume.
• To assess graft survival rates in pediatric liver transplant recipients.

Main Methods:

• Analysis of national liver transplant waiting list data before and after the Share 35 policy implementation.
• Comparison of median waiting times and mortality rates for patients with MELD ≥ 35.
• Examination of pediatric candidate demographics, transplant numbers (deceased and living donor), and graft survival.

Main Results:

• Median waiting time for MELD ≥ 35 patients decreased from 18 to 9 days post-Share 35.
• Mortality for MELD ≥ 35 candidates decreased from 366 to 315 per 100 waitlist years.
• Pediatric liver transplants showed improved graft survival for both deceased and living donor recipients.

Conclusions:

• The Share 35 policy effectively reduced waiting times and mortality for critically ill liver transplant candidates.
• Trends in pediatric liver transplantation indicate a declining waiting list and stable transplant volume.
• Continuous improvement in graft survival highlights advancements in pediatric liver transplant care.