Related Experiment Video
Updated: May 4, 2026
14:52
Re-Arterialized Rat Partial Liver Transplantation with an in vivo Vessel-Oriented 70% Hepatectomy
Published on: April 8, 2018
12.1K
Same policy, different impact: Center-level effects of share 35 liver allocation
Douglas R Murken1, Allison W Peng1, David D Aufhauser1
1Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA.
Summary
The Share 35 policy boosted liver transplants for patients with high Model for End-Stage Liver Disease (MELD) scores. However, transplant centers responded differently, with a few performing most of the increase.
Area of Science:
- Organ transplantation research
- Health policy analysis
- Liver disease management
Background:
- The Share 35 policy aimed to increase liver transplants for critically ill patients.
- Understanding how transplant centers adapted to Share 35 is vital for policy optimization.
Purpose of the Study:
- To analyze center-specific changes in liver transplant volumes after the Share 35 policy implementation.
- To characterize variations in practice patterns among transplant centers.
Main Methods:
- Utilized United Network for Organ Sharing data to compare center volumes of allocation-Model for End-Stage Liver Disease (aMELD) ≥ 35 transplants before and after Share 35.
- Analyzed patient listing trends and compared pre- and post-transplant MELD scores.
Main Results:
- Significant variation existed in center-level increases in aMELD ≥ 35 transplants.
- A small number of centers accounted for a disproportionately large share of the national increase.
- Some patients transplanted under aMELD ≥ 35 did not have a laboratory MELD ≥ 35 at the time of transplant.
Conclusions:
- Share 35 increased national liver transplantation rates for high-MELD patients but impacted centers asymmetrically.
- Further research is needed to evaluate long-term outcomes at centers with substantial increases in high-MELD transplants.
More Related Videos
Related Concept Videos
01:16Hepatic Drug Excretion: Influencing Factors
818
The biliary system of the liver, crucial for bile secretion and drug excretion, comprises intrahepatic bile ducts that merge to form the common hepatic duct. This duct, carrying hepatic bile, combines with the cystic duct, draining the gallbladder and forming the common bile duct, which empties into the duodenum. Bile, produced by hepatic cells lining the bile canaliculi, is composed primarily of water, bile salts, pigments, electrolytes, and lesser amounts of cholesterol and fatty acids. Bile...
818
01:09Hepatic Drug Clearance: Restrictive and Nonrestrictive Clearance
781
Hepatic clearance refers to the volume of blood cleared of a drug by the liver per unit of time. It plays a crucial role in drug metabolism and elimination. While hepatic clearance is commonly estimated by subtracting renal clearance from total body clearance, other pathways, such as pulmonary or biliary clearance, may also contribute. However, these pathways are generally less significant than hepatic and renal clearance.
Most drugs undergo restrictive clearance, which is proportional to the...
Most drugs undergo restrictive clearance, which is proportional to the...
781
01:09Hepatic Drug Clearance: Effect of Protein Binding
725
Hepatic clearance is influenced by protein binding based on the drug's extraction ratio. Drugs with high extraction ratios are considered flow-limited and remain unaffected by protein binding during hepatic clearance. On the other hand, drugs with low extraction ratios may be impacted by plasma protein binding, although the extent of this influence depends on the fraction of the drug bound.
For low-extraction-ratio drugs that are less than 80% protein-bound, minor changes in protein binding...
For low-extraction-ratio drugs that are less than 80% protein-bound, minor changes in protein binding...
725
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow
382
Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug...
382
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
271
In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess...
271
01:08Effect of Hepatic Disease on Pharmacokinetics: Dose Adjustments Due to Hepatic Impairment
379
Hepatic impairment, characterized by decreased liver function, does not uniformly mandate adjustments in drug dosage. Whether dosage modifications are necessary depends on various factors related to the drug's metabolism and elimination pathways. If a drug is primarily excreted via the kidneys and bypasses significant hepatic processing, if it undergoes minimal metabolic transformation in the liver, or if it is volatile and primarily expelled through the lungs, dose adjustments may not be...
379