Murken Douglas R, Peng Allison W, Aufhauser David D, Abt Peter L, Goldberg David S, Levine Matthew H
Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA.
Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA.
Liver Transpl. 2017 Jun;23(6):741-750. doi: 10.1002/lt.24769.
Early studies of national data suggest that the Share 35 allocation policy increased liver transplants without compromising posttransplant outcomes. Changes in center-specific volumes and practice patterns in response to the national policy change are not well characterized. Understanding center-level responses to Share 35 is crucial for optimizing the policy and constructing effective future policy revisions. Data from the United Network for Organ Sharing were analyzed to compare center-level volumes of allocation-Model for End-Stage Liver Disease (aMELD) ≥ 35 transplants before and after policy implementation. There was significant center-level variation in the number and proportion of aMELD ≥ 35 transplants performed from the pre- to post-Share 35 period; 8 centers accounted for 33.7% of the total national increase in aMELD ≥ 35 transplants performed in the 2.5-year post-Share 35 period, whereas 25 centers accounted for 65.0% of the national increase. This trend correlated with increased listing at these centers of patients with Model for End-Stage Liver Disease (MELD) ≥ 35 at the time of initial listing. These centers did not overrepresent the total national volume of liver transplants. Comparison of post-Share 35 aMELD to calculated time-of-transplant (TOT) laboratory MELD scores showed that only 69.6% of patients transplanted with aMELD ≥ 35 maintained a calculated laboratory MELD ≥ 35 at the TOT. In conclusion, Share 35 increased transplantation of aMELD ≥ 35 recipients on a national level, but the policy asymmetrically impacted practice patterns and volumes of a subset of centers. Longer-term data are necessary to assess outcomes at centers with markedly increased volumes of high-MELD transplants after Share 35. Liver Transplantation 23 741-750 2017 AASLD.
早期对全国数据的研究表明，“共享35”分配政策增加了肝移植数量，且未对移植后结果产生不利影响。针对国家政策变化，各中心特定的移植量和实践模式的改变尚未得到充分描述。了解各中心对“共享35”政策的反应对于优化该政策以及制定未来有效的政策修订至关重要。对器官共享联合网络的数据进行分析，以比较政策实施前后终末期肝病模型（aMELD）≥35分的移植分配量在各中心的情况。从“共享35”政策实施前到实施后，aMELD≥35分的移植数量和比例在各中心层面存在显著差异；在“共享35”政策实施后的2.5年里，8个中心占全国aMELD≥35分移植总数增加量的33.7%，而25个中心占全国增加量的65.0%。这一趋势与这些中心终末期肝病模型（MELD）≥35分的患者在初次登记时登记数量的增加相关。这些中心在全国肝移植总量中并不占过高比例。将“共享35”政策实施后的aMELD与计算得出的移植时（TOT）实验室MELD评分进行比较，结果显示，接受aMELD≥35分移植的患者中，只有69.6%在移植时其计算得出的实验室MELD评分仍≥35分。总之，“共享35”政策在全国范围内增加了aMELD≥35分受者的移植数量，但该政策对一部分中心的实践模式和移植量产生了不对称影响。需要长期数据来评估“共享35”政策实施后高MELD移植量显著增加的中心的移植结果。《肝脏移植》2017年第23卷741 - 750页 美国肝病研究学会
