Halazun K J, Mathur A K, Rana A A, Massie A B, Mohan S, Patzer R E, Wedd J P, Samstein B, Subramanian R M, Campos B D, Knechtle S J
Division of Liver Transplantation and Hepatobiliary Surgery, Department of Surgery, Weill Cornell Medical College, New York, NY.
Department of Surgery and Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ.
Am J Transplant. 2016 Jan;16(1):137-42. doi: 10.1111/ajt.13500. Epub 2015 Nov 12.
Allocation policies for liver transplantation underwent significant changes in June 2013 with the introduction of Share 35. We aimed to examine the effect of Share 35 on regional variation in posttransplant outcomes. We examined two patient groups from the United Network for Organ Sharing dataset; a pre-Share 35 group composed of patients transplanted between June 17, 2012, and June 17, 2013 (n = 5523), and a post-Share group composed of patients transplanted between June 18, 2013, and June 18, 2014 (n = 5815). We used Kaplan-Meier and Cox multivariable analyses to compare survival. There were significant increases in allocation Model for End-stage Liver Disease (MELD) scores, laboratory MELD scores, and proportions of patients in the intensive care unit and on mechanical, ventilated, or organ-perfusion support at transplant post-Share 35. We also observed a significant increase in donor risk index in this group. We found no difference on a national level in survival between patients transplanted pre-Share 35 and post-Share 35 (p = 0.987). Regionally, however, posttransplantation survival was significantly worse in the post-Share 35 patients in regions 4 and 10 (p = 0.008 and p = 0.04), with no significant differences in the remaining regions. These results suggest that Share 35 has been associated with transplanting "sicker patients" with higher MELD scores, and although no difference in survival is observed on a national level, outcomes appear to be concerning in some regions.
随着2013年6月“共享35”政策的出台，肝移植分配政策发生了重大变化。我们旨在研究“共享35”政策对移植后结局区域差异的影响。我们从器官共享联合网络数据集中选取了两组患者；一组是“共享35”政策实施前的患者，于2012年6月17日至2013年6月17日接受移植（n = 5523），另一组是“共享”政策实施后的患者，于2013年6月18日至2014年6月18日接受移植（n = 5815）。我们使用Kaplan-Meier和Cox多变量分析来比较生存率。在“共享35”政策实施后，移植时终末期肝病模型（MELD）评分、实验室MELD评分以及重症监护病房患者比例和接受机械通气、器官灌注支持患者比例均显著增加。我们还观察到该组供体风险指数显著升高。我们发现，在全国范围内，“共享35”政策实施前和实施后接受移植的患者生存率没有差异（p = 0.987）。然而，在区域层面，第4和第10区“共享35”政策实施后的患者移植后生存率显著更差（p = 0.008和p = 0.04），其余区域无显著差异。这些结果表明，“共享35”政策与移植MELD评分更高的“病情更重的患者”有关，虽然在全国层面未观察到生存率差异，但在某些区域结局似乎令人担忧。
