Washburn Kenneth, Harper Ann, Baker Timothy, Edwards Erick
Transplant Center, University of Texas Health Science Center, San Antonio, TX.
United Network for Organ Sharing, Richmond, VA.
Liver Transpl. 2016 Feb;22(2):171-7. doi: 10.1002/lt.24348.
The Share 35 policy was implemented June 2013. We sought to evaluate liver offer acceptance patterns of centers under this policy. We compared three 1-year eras (1, 2, and 3) before and 1 era (4) after the implementation date of the Share 35 policy (June 18, 2013). We evaluated all offers for liver-only recipients including only those offers for livers that were ultimately transplanted. Logistic regression was used to develop a liver acceptance model. In era 3, there were 4809 offers for Model for End-Stage Liver Disease (MELD) score ≥ 35 patients with 1071 acceptances (22.3%) and 10,141 offers and 1652 acceptances (16.3%) in era 4 (P < 0.001). In era 3, there were 42,954 offers for MELD score < 35 patients with 4181 acceptances (9.7%) and 44,137 offers and 3882 acceptances (8.8%) in era 4 (P < 0.001). The lower acceptance rate persisted across all United Network for Organ Sharing regions and was significantly less in regions 2, 3, 4, 5, and 7. Mean donor risk index was the same (1.3) for all eras for MELD scores ≥ 35 acceptances and the same (1.4) for MELD score < 35 acceptances. Refusal reasons did not vary throughout the eras. The adjusted odds ratio of accepting a liver for a MELD score of 35 + compared to a MELD score < 35 patient was 1.289 before the policy and 0.960 after policy implementation. In conclusion, the Share 35 policy has resulted in more offers to patients with MELD scores ≥ 35. Overall acceptance rates were significantly less compared to the same patient group before the policy implementation. Centers are less likely to accept a liver for a patient with a MELD score of 35 + after the policy change. Decreased donor acceptance rates could reflect more programmatic selectivity and ongoing donor and recipient matching.
“共享35”政策于2013年6月实施。我们试图评估在该政策下各中心对肝脏供体接受情况的模式。我们比较了“共享35”政策实施日期（2013年6月18日）之前的三个1年时间段（第1、2和3阶段）以及之后的一个时间段（第4阶段）。我们评估了仅针对肝脏移植受者的所有供体情况，仅包括那些最终进行了肝脏移植的供体。使用逻辑回归建立肝脏接受模型。在第3阶段，有4809次向终末期肝病模型（MELD）评分≥35的患者提供肝脏，其中1071例被接受（22.3%）；在第4阶段，有10141次提供肝脏，1652例被接受（16.3%）（P<0.001）。在第3阶段，有42954次向MELD评分<35的患者提供肝脏，其中4181例被接受（9.7%）；在第4阶段，有44137次提供肝脏，3882例被接受（8.8%）（P<0.001）。较低的接受率在器官共享联合网络的所有地区都持续存在，在第2、3、4、5和7地区显著更低。对于MELD评分≥35的接受肝脏移植者，所有阶段的平均供体风险指数相同（1.3）；对于MELD评分<35的接受者，平均供体风险指数也相同（1.4）。各阶段拒绝的原因没有变化。与MELD评分<35的患者相比，MELD评分为35及以上的患者接受肝脏移植的调整优势比在政策实施前为1.289，政策实施后为0.960。总之，“共享35”政策导致向MELD评分≥35的患者提供了更多肝脏供体。与政策实施前的同一患者群体相比，总体接受率显著降低。政策改变后，各中心为MELD评分为35及以上的患者接受肝脏移植的可能性降低。供体接受率的下降可能反映了更多的项目选择性以及持续的供体和受体匹配情况。
