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Related Concept Videos

Kidney Transplant I: Introduction01:28

Kidney Transplant I: Introduction

611
A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Kidney Transplant II: Surgical Procedure01:26

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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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Share 35 changes in center-level liver acceptance practices.

David S Goldberg1,2,3, Matthew Levine4, Seth Karp5

  • 1Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA.

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
|February 28, 2017
PubMed
Summary
This summary is machine-generated.

The Share 35 policy decreased liver offer acceptance for patients with Model for End-Stage Liver Disease (MELD) scores of 35 or higher. This suggests changes in transplant center practices after policy implementation.

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Area of Science:

  • Transplantation Medicine
  • Organ Allocation Policy
  • Hepatology

Background:

  • The Share 35 policy aimed to improve organ access for patients with high Model for End-Stage Liver Disease (MELD) scores (≥35).
  • The impact of Share 35 on organ offer acceptance rates remains largely unknown.

Purpose of the Study:

  • To evaluate the effect of the Share 35 policy on liver organ offer acceptance rates.
  • To analyze changes in acceptance rates across different MELD score categories and geographic regions.

Main Methods:

  • Analysis of adult liver offers for transplanted patients between January 1, 2011, and December 31, 2015.
  • Utilized multilevel mixed-effects models, accounting for patient and transplant center clustering.
  • Focused on patients within the top 5 match run positions.

Main Results:

  • Liver offer acceptance decreased by 36% for patients with MELD scores ≥35 after Share 35 implementation (adjusted OR, 0.64).
  • No significant difference in donor risk index for declined livers in the pre- vs. post-Share 35 eras.
  • Organ offer acceptance rates declined across all regions for MELD ≥35 patients, with greater decreases in regions without prior regional sharing.

Conclusions:

  • The Share 35 policy led to a significant decline in liver offer acceptance for candidates with MELD scores ≥35.
  • Observed changes in acceptance rates indicate shifts in transplant center practices.
  • Broader organ sharing policies may present logistical challenges and increase organ discard rates, potentially reducing national transplant numbers.