TY - JOUR
T1 - Increased access to liver transplantation for patients with acute on chronic liver failure after implementation of Share 35 Rule
T2 - An analysis from the UNOS database
AU - Laique, Sobia N.
AU - Zhang, Nan
AU - Hewitt, Winston R.
AU - Bajaj, Jasmohan
AU - Vargas, Hugo E.
N1 - Publisher Copyright:
© 2020 Fundación Clínica Médica Sur, A.C.
PY - 2021/7/1
Y1 - 2021/7/1
N2 - Introduction and objectives: Acute on chronic liver failure (ACLF), leads to high mortality. These patients are at risk of being delisted for liver transplantation (LT). Emerging data shows 1y post-transplant survival of 80–92%. The Share 35 (S35) policy was implemented to prioritize patients with MELD ≥35 on the LT waitlist. Our aim was to compare the LT outcomes of ACLF patients as a result of S35. Materials and methods: Data from the UNOS scientific registry were used to classify ACLF patients using the NACSELD criteria. For the analyses, data were divided into two eras; 2 years before S35 (Era 1) and 2 years after S35 (Era 2). Waitlist status was classified into categories: Transplanted, Death or Too Sick to Transplant and Still Waiting/Other. LT cumulative incidence between the populations in the eras was calculated using Fine and Gray's method. A proportional hazards model was used to investigate the era effect on cumulative incidence of LT. Results: 46,861 patients were reviewed, of which 817 had ACLF. 366 patients (mean MELD: 37.1) were identified in Era 1 and 451 patients (mean MELD: 37.3) in Era 2. We found that ACLF patients were more likely to receive a liver transplant in Era 2 (p = 0.0074). In both eras, transplanted patients had a significantly higher survival than those who were not transplanted (p < 0.0001). Conclusions: Our study shows that S35 improved LT rate for ACLF suggesting that there should be broader recognition of ACLF and early transplantation should be pursued.
AB - Introduction and objectives: Acute on chronic liver failure (ACLF), leads to high mortality. These patients are at risk of being delisted for liver transplantation (LT). Emerging data shows 1y post-transplant survival of 80–92%. The Share 35 (S35) policy was implemented to prioritize patients with MELD ≥35 on the LT waitlist. Our aim was to compare the LT outcomes of ACLF patients as a result of S35. Materials and methods: Data from the UNOS scientific registry were used to classify ACLF patients using the NACSELD criteria. For the analyses, data were divided into two eras; 2 years before S35 (Era 1) and 2 years after S35 (Era 2). Waitlist status was classified into categories: Transplanted, Death or Too Sick to Transplant and Still Waiting/Other. LT cumulative incidence between the populations in the eras was calculated using Fine and Gray's method. A proportional hazards model was used to investigate the era effect on cumulative incidence of LT. Results: 46,861 patients were reviewed, of which 817 had ACLF. 366 patients (mean MELD: 37.1) were identified in Era 1 and 451 patients (mean MELD: 37.3) in Era 2. We found that ACLF patients were more likely to receive a liver transplant in Era 2 (p = 0.0074). In both eras, transplanted patients had a significantly higher survival than those who were not transplanted (p < 0.0001). Conclusions: Our study shows that S35 improved LT rate for ACLF suggesting that there should be broader recognition of ACLF and early transplantation should be pursued.
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U2 - 10.1016/j.aohep.2020.100288
DO - 10.1016/j.aohep.2020.100288
M3 - Article
C2 - 33217586
AN - SCOPUS:85100218998
SN - 1665-2681
VL - 23
JO - Annals of hepatology
JF - Annals of hepatology
M1 - 100288
ER -