Improvement in the Outcomes of MELD >= 40 Liver Transplantation: An Analysis of 207 Consecutive Transplants in a Highly Competitive DSA.

Background: Organ donor shortages continue to persist, especially in regions of the United States where competition is highest and recipients frequently attain a MELD score >= 40 prior to transplantation. The benefits of Share 35 in highly competitive regions may be underestimated when examining the collective national experience. The purpose of this study is to examine the outcomes of liver transplantation in recipients with a MELD >= 40 after implementation of Share 35 in a single center located in region 5. Methods: Single center retrospective analysis of 207 liver transplant recipients who achieved MELD score >= 40 from 4/21/2002 - 5/15/2015. Results: Multivariable analysis identified implementation of Share 35 as the strongest predictor of graft survival in MELD >= 40 liver transplantation. The post-Share 35 1-year graft survival was 94% compared to 75% pre-Share 35 (p=0.002). Post-Share 35 recipients waited significantly less time until transplantation (10 vs 16 days, p=0.015) and fewer were hospitalized for >28 days prior to their transplant (6% vs 18%, p=0.05). Multivariable analysis identified recipients with diabetes at the time of listing as the strongest predictor of posttransplant patient mortality. Conclusions: Implementation of the Share 35 allocation policy has a significant effect on outcomes by improving organ access and minimizing candidate waiting times. Recipients achieving a MELD >= 40 at our center post-Share 35 had an improved 1-year graft survival. However, nearly 40% remained hospitalized >4 weeks posttransplant and 20% were discharged to an acute care facility. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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