The effect of Share 35 on biliary complications: An interrupted time series analysis

Area of Science:

• Hepatology
• Transplant Surgery
• Health Policy Analysis

Background:

• The Share 35 policy aimed to improve liver transplant waitlist mortality by prioritizing high Model for End-Stage Liver Disease (MELD) patients.
• Policy implementation can lead to unforeseen outcomes that require careful evaluation alongside primary objectives.

Purpose of the Study:

• To assess the impact of the Share 35 allocation policy on the incidence of biliary complications in liver transplant recipients.
• To identify potential unintended consequences of the Share 35 policy.

Main Methods:

• An interrupted time series analysis was conducted using the Vizient CDB/RM database.
• Liver transplants performed between October 2012 and September 2015 were included, comparing pre- and post-Share 35 cohorts.
• A subanalysis in Region 9 transplant centers with a prior broad sharing agreement served as a control.

Main Results:

• A significant increase in the incident rate of biliary complications was observed after the implementation of Share 35 (P = .023).
• The control group in Region 9 showed no significant change in biliary complication rates.
• Post-policy changes in length of stay and direct costs were noted but did not reach statistical significance.

Conclusions:

• The Share 35 policy, while targeting improved waitlist mortality, was associated with an increased incidence of biliary complications.
• Unintended consequences, such as changes in complication rates, must be considered for a comprehensive assessment of organ allocation policies.
• Further research is warranted to fully understand and mitigate the adverse effects of organ allocation policy changes.