Effects of Major Liver Allocation Policy Changes on Waitlist Outcomes in Multivisceral Transplantation

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Conference Proceeding

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Publication Title

Am J Transplant


Purpose: Liver-intestine allocation is determined in the liver waitlist. This study aimed to evaluate effects of recent updates in liver allocation policy on waitlist outcomes in liver-intestine (multivisecral) transplant (MVT). Methods: We examined adult patients who were registered for liver-alone/liver-kidney transplant (LTA/LKT), and MVT between 2011 and 2018 by using the UNOS registry. Registration periods were grouped according to the recent revisions of liver allocation; pre-Share 35 (1/1/2011-6/17/2013), post-Share 35 (6/18/2013-1/10/2016). and MELDNa (1/11/2016-3/31/2018). 90-day waitlist mortality in MVT and LTA/LKT candidates were evaluated and effects of allocation changes were compared. Results: The number of LTA/LKT candidates listed with score of >29 significantly increased over penods (128, 149, and 189/month in pre-Share 35, post-Share 35. and MELDNa periods, respectively; PO. 001). A risk of 90 day-waitlist mortality in LTA/LKT candidates with MELD score of 20-28 decreased over periods (hazard ratio [HR], 0. 91 and 0. 82; P-0. 042 and <0. 001 for pre vs. post-Share 35 and post-Share 35 vs. MELDNa). In those with score of 29-34, a risk of 90-day morality significantly decreased in the MELDNa period (HR, 0. 78; PO. 001 [ref post-Share 35]). In MVT candidates, while no difference in 90-day mortality between pre and post-Share 35 (HR, 0. 96; PO. 29), it significantly increased in the MELDNa period (HR, 1. 08; P-0. 02 [ref. post-Share 35]). Conclusions: Exception score for MVT candidates may need to be reconsidered. given the adverse impact of MELDNa based allocation which might be associated with the increasing number of high score patients.



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