Effects of Major Liver Allocation Policy Changes on Waitlist Outcomes in Multivisceral Transplantation
Nagai S, Rizzari M, Muszkat Y, Collins K, Yoshida A, Jafri S, and Abouljoud M. Effects of Major Liver Allocation Policy Changes on Waitlist Outcomes in Multivisceral Transplantation. Am J Transplant 2019; 19:1164.
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.