Impact of Share 35 liver transplantation allocation in Australia and New Zealand.

end stage liver disease graft survival mortality survival waiting lists

Journal

Clinical transplantation
ISSN: 1399-0012
Titre abrégé: Clin Transplant
Pays: Denmark
ID NLM: 8710240

Informations de publication

Date de publication:
13 Dec 2023
Historique:
revised: 30 10 2023
received: 14 03 2023
accepted: 19 11 2023
medline: 13 12 2023
pubmed: 13 12 2023
entrez: 13 12 2023
Statut: aheadofprint

Résumé

Patients with high model for end-stage liver disease (MELD) scores waiting for liver transplantation in Australia and New Zealand (ANZ) have had limited access to deceased donor livers and therefore binational sharing of livers, for patients with a MELD score ≥35 was introduced in February 2016. Waiting list mortality, post-transplant outcomes and intention-to-treat survival were compared between patients whose MELD score reached 35 on the waiting list between October 2013 and April 2015 (Pre-Share 35 group, n = 23) and patients who were Share 35 listed between February 2016 and May 2022 (Share 35 group, n = 112). There was significantly reduced waiting list mortality in share 35 listed patients in comparison to the pre-Share 35 group (11.7% vs. 52.2%, OR .120 95% CI .044-.328, P < .001). Post-transplant patient and graft survival were not significantly different between the groups (5-year patient survival 82% vs. 84%, P = .991, 5-year graft survival 82% vs. 76%, P = .543). Intention-to-treat survival was superior in the Share 35 group (HR .302, 95% CI .149-.614, P < .001). Introduction of Share 35 in ANZ resulted in a 78% risk reduction in waiting list mortality, equivalent post-transplant survival and an improvement in intention-to-treat survival.

Identifiants

DOI: 10.1111/ctr.15203 PMID: 38088459
pubmed: 38088459
doi: 10.1111/ctr.15203
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e15203

Informations de copyright

© 2023 The Authors. Clinical Transplantation published by John Wiley & Sons Ltd.

Références

McCaughan GW, Munn SR. Liver transplantation in Australia and New Zealand. Liver Transpl. 2016;22(6):830-838. doi:10.1002/lt.24446
Transplantation Society of Australia and New Zealand Clinical guidelines for organ transplantation from deceased donors. 2021. Available at: Accessed 17/08/2021. https://tsanz.com.au/storage/documents/TSANZ_Clinical_Guidelines_Version-16_11052021.pdf
Hey P, Hanrahan TP, Sinclair M, et al. Epidemiology and outcomes of acute liver failure in Australia. World J Hepatol. 2019;11(7):586-595. doi:10.4254/wjh.v11.i7.586
Ma FinkB, M. (eds.). Australia and New Zealand Liver and Intestinal Transplant Registry Annual Report 2020. 2020. Available at: Accessed 18/0/12022. https://www.anzlitr.org/wp-content/uploads/2021/12/32ndANZLITR_AnnualReport.pdf
Fink MA, Berry SR, Gow PJ, et al. Risk factors for liver transplantation waiting list mortality. J Gastroenterol Hepatol. 2007;22(1):119-124. doi:10.1111/j.1440-1746.2006.04422.x
Fink M. Optimising the Management of Patients Awaiting Liver Transplantation (Doctor of Medicine Thesis). The University of Melbourne; 2016. Available at: Accessed 11/08/2023. https://rest.neptune-prod.its.unimelb.edu.au/server/api/core/bitstreams/6cda99b6-6a0f-53bc-b99a-6564e5736a08/content
Sharma P, Schaubel DE, Gong Q, Guidinger M, Merion RM. End-stage liver disease candidates at the highest model for end-stage liver disease scores have higher wait-list mortality than status-1A candidates. Hepatology. 2012;55(1):192-198. doi:10.1002/hep.24632
Massie AB, Chow EKH, Wickliffe CE, et al. Early changes in liver distribution following implementation of Share 35. Am J Transpl. 2015;15(3):659-667. doi:10.1111/ajt.13099
Kim WR, Lake JR, Smith JM, et al. OPTN/SRTR 2013 annual data report: liver. Am J Transpl. 2015;15(2):1-28. doi:10.1111/ajt.13197. Suppl.
Kim WR, Lake JR, Smith JM, et al. LIVER. Am J Transpl. 2016;16:69-98. doi:10.1111/ajt.13668
Nekrasov V, Matsuoka L, Rauf M, et al. National outcomes of liver transplantation for model for end-stage liver disease score ≥40: the impact of Share 35. Am J Transpl. 2016;16(10):2912-2924. doi:10.1111/ajt.13823
Annamalai A, Ayoub W, Sundaram V, Klein A. First look: one year since inception of regional Share 35 policy. Transpl Proc. 2015;47(6):1585-1590. doi:10.1016/j.transproceed.2015.06.006
Edwards EB, Harper AM, Hirose R, Mulligan DC. The impact of broader regional sharing of livers: 2-year results of “Share 35”. Liver Transpl. 2016;22(4):399-409. doi:10.1002/lt.24418
International registry in organ donation and transplantation newsletter. 2014. available at: accessed 13/08/2023. https://www.irodat.org/img/database/pdf/NEWSLETTER2015_December2.pdf
International registry in organ donation and transplantation newsletter. 2021. available at: accessed 13/08/2023. https://www.irodat.org/img/database/pdf/Irodat%20December_final%202020.pdf
Malik AK, Masson S, Allen E, et al. Impact of regional organ sharing and allocation in the UK northern liver alliance on waiting time to liver transplantation and waitlist survival. Transplantation. 2019;103(11):2304-2311. doi:10.1097/TP.0000000000002687
Zaccaria R, Teti G, Mecule A, Torlone N, Valeri M, Adorno D. Liver graft allocation by means of a new, regionally shared “mixed” model: the experience in Lazio. Transpl Proc. 2015;47(7):2113-2115. doi:10.1016/j.transproceed.2014.11.075
Chow EKH, Massie AB, Luo X, et al. Waitlist outcomes of liver transplant candidates who were reprioritized under Share 35. Am J Transpl. 2017;17(2):512-518. doi:10.1111/ajt.13980
Halazun KJ, Mathur AK, Rana AA, et al. One size does not fit all-regional variation in the impact of the Share 35 liver allocation policy. Am J Transpl. 2016;16(1):137-142. doi:10.1111/ajt.13500
Zhang Y, Boktour MR. Effects of Share 35 policy on liver transplantation outcomes for patients with nonalcoholic steatohepatitis. Progr Transpl. 2019;29(3):248-253. doi:10.1177/1526924819854481
Kwong AJ, Goel A, Mannalithara A, Kim WR. Improved posttransplant mortality after share 35 for liver transplantation. Hepatology. 2018;67(1):273-281. doi:10.1002/hep.29301
Berumen J, Misel M, Vodkin I, Halldorson JB, Mekeel KL, Hemming A. The effects of Share 35 on the cost of liver transplantation. Clin Transpl. 2017;31(5). doi:10.1111/ctr.12937. e12937.
Fernandez H, Weber J, Barnes K, Wright L, Levy M. Financial impact of liver sharing and organ procurement organizations’ experience with Share 35: implications for national broader sharing. Am J Transpl. 2016;16(1):287-291. doi:10.1111/ajt.13436
Fleming JN, Taber DJ, Axelrod D, Chavin KD. The effect of Share 35 on biliary complications: an interrupted time series analysis. Am J Transpl. 2019;19(1):221-226. doi:10.1111/ajt.14937
Nicolas CT, Nyberg SL, Heimbach JK, et al. Liver transplantation after share 35: impact on pretransplant and posttransplant costs and mortality. Liver Transpl. 2017;23(1):11-18. doi:10.1002/lt.24641

Auteurs

Michael A Fink (MA)

Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia.
Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia.
Australia and New Zealand Liver and Intestinal Transplant Registry, Melbourne, Australia.
ORCID: 0000-0002-9684-4691

Paul J Gow (PJ)

Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia.

Geoffrey W McCaughan (GW)

University of Sydney, Sydney, New South Wales, Australia.
Liver Injury and Cancer, Centenary Institute, Camperdown, New South Wales, Australia.
Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia.

Peter Hodgkinson (P)

Queensland Liver Transplant Service, Princess Alexandra Hospital and Queensland Children's Hospital, Brisbane, Australia.

John Chen (J)

Flinders Medical Centre, Adelaide, South Australia, Australia.

John McCall (J)

University of Auckland, Auckland, New Zealand.
New Zealand Liver Transplant Service, Auckland City Hospital, Auckland, New Zealand.

Bryon Jaques (B)

Western Australian Liver Transplant Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.

Michael Crawford (M)

University of Sydney, Sydney, New South Wales, Australia.
Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia.

Simone I Strasser (SI)

University of Sydney, Sydney, New South Wales, Australia.
Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia.

Winita Hardikar (W)

Gastroenterology and Clinical Nutrition Department Royal Children's Hospital, Melbourne, Victoria, Australia.

Mark Brooke-Smith (M)

Flinders Medical Centre, Adelaide, South Australia, Australia.

Graham Starkey (G)

Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia.

Gary P Jeffrey (GP)

Western Australian Liver Transplant Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
Medical School, The University of Western Australia, Perth, Western Australia, Australia.

Ed Gane (E)

University of Auckland, Auckland, New Zealand.
New Zealand Liver Transplant Service, Auckland City Hospital, Auckland, New Zealand.

Michael Stormon (M)

University of Sydney, Sydney, New South Wales, Australia.
Australian National Liver Transplantation Service, Children's Hospital at Westmead, Sydney, New South Wales, Australia.

Helen Evans (H)

University of Auckland, Auckland, New Zealand.
Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand.

Caroline Tallis (C)

Queensland Liver Transplant Service, Princess Alexandra Hospital and Queensland Children's Hospital, Brisbane, Australia.

Amanda J Byrne (AJ)

Australia and New Zealand Liver and Intestinal Transplant Registry, Melbourne, Australia.

Robert M Jones (RM)

Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia.
Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia.

Classifications MeSH