Brooks Joseph T, Koizumi Naoru, Neglia Elizabeth, Gdoura Bilel, Wong Tina W, Kwon Chang, Smith Tony E, Ortiz Jorge
Department of Surgery, University of Toledo, Toledo, OH, USA.
Schar School of Policy and Government, George Mason University, Arlington, VA, USA; Department of Surgery, George Washington University Hospital, Washington, DC, USA.
HPB (Oxford). 2018 Jul;20(7):649-657. doi: 10.1016/j.hpb.2018.01.007. Epub 2018 Feb 28.
Share 35 prioritizes offers of deceased donor livers to regional candidates with Model for End-Stage Liver Disease (MELD) ≥35 over local candidates with lower MELD scores. Analysis of Share35 has shown that overall 1- or 2-year post-transplant (LTx) outcomes have been unchanged while waitlist mortality has been reduced. However, these studies exclude retransplant (reLTx) recipients. This study aims to investigate the outcomes of liver retransplants in evaluating the impact of the Share35 policy.
A retrospective analysis of data from the United Network for Organ Sharing database over the period June 2011-June 2015 was performed.
A total of 19,748 LTx and 312 reLTx recipients were identified. Of the LTx recipients, 9626 (48.7%) underwent transplant pre-Share 35 and 10,122 (51.3%) post-Share 35. 123 (39.4%) reLTx recipients underwent retransplantation pre-Share 35 and 189 (60.6%) post-Share 35. ReLTx recipients experienced improved 2-year graft survival post-Share 35 compared to pre-Share 35 (67% vs. 21.1%). Patient survival also improved at 2-years for reLTx recipients post-Share 35 compared to pre-Share 35 (69.2% vs. 33.1%). Transplant post-Share 35 was protective for both 2-year graft (HR = 0.669, CI = 0.454-0.985, p = 0.04) and patient (HR = 0.659, CI = 0.44-0.987, p = 0.003) survival.
Share35 is associated with improved outcomes after retransplantation.
“共享35”政策优先将已故捐赠者肝脏提供给终末期肝病模型（MELD）评分≥35的区域候选人，而非MELD评分较低的本地候选人。对“共享35”政策的分析表明，总体而言，移植后1年或2年的结局未变，但等待名单上的死亡率有所降低。然而，这些研究排除了再次移植（reLTx）受者。本研究旨在调查肝脏再次移植的结局，以评估“共享35”政策的影响。
对器官共享联合网络数据库2011年6月至2015年6月期间的数据进行回顾性分析。
共识别出19748例肝移植（LTx）受者和312例再次肝移植（reLTx）受者。在LTx受者中，9626例（48.7%）在“共享35”政策实施前接受移植，10122例（51.3%）在“共享35”政策实施后接受移植。123例（39.4%）reLTx受者在“共享35”政策实施前接受再次移植，189例（60.6%）在“共享35”政策实施后接受再次移植。与“共享35”政策实施前相比，reLTx受者在“共享35”政策实施后的2年移植物存活率有所提高（67%对21.1%）。与“共享35”政策实施前相比，reLTx受者在“共享35”政策实施后的2年患者存活率也有所提高（69.2%对33.1%）。“共享35”政策实施后的移植对2年移植物（风险比[HR]=0.669，可信区间[CI]=0.454-0.985，p=0.04）和患者（HR=0.659，CI=0.44-0.987，p=0.003）存活率均具有保护作用。
“共享35”政策与再次移植后结局改善相关。
