Effects of Share 35 Policy on Liver Transplantation Outcomes for Patients With Nonalcoholic Steatohepatitis.
BACKGROUND
To examine the temporal variation and outcomes of liver transplantation between pre- and post-Share 35 eras for patients with nonalcoholic steatohepatitis.


METHODS
A retrospective analysis was performed among 4380 patients with end-stage liver disease from the United Network for Organ Sharing database from 2009 to 2017 due to primary diagnosis of nonalcoholic steatohepatitis or cryptogenic cirrhosis with body mass index greater than 30. Cox regressions were used to model the effect of Share 35 policy on patient and graft survival comparing the first 3 years of Share 35 policy to an equivalent time period before.


RESULTS
The number of nonalcoholic steatohepatitis-related transplants increased from 232 (14.1%) in 2009 to 266 (20.5%) in 2017. In post-Share 35 era, average waitlist time and cold ischemic time decreased, while Model for End-Stage Liver Disease (MELD) scores increased with higher proportion of recipients having MELD ≥35. No significant difference in average length of hospitalization or survival was found after Share 35.


CONCLUSIONS
The Share 35 policy benefits patients with nonalcoholic steatohepatitis from reduced liver transplantation waiting time. It is also associated with comparable outcomes in 2 eras without increasing cold ischemic time or posttransplant length of hospitalization.
['Zhang|Yefei|Y|', 'Boktour|Maha R|MR|']
D000368:Aged D050377:Cold Ischemia D058625:End Stage Liver Disease D005260:Female D006801:Humans D007902:Length of Stay D016031:Liver Transplantation D008297:Male D008875:Middle Aged D065626:Non-alcoholic Fatty Liver Disease D016134:Organizational Policy D018579:Patient Selection D016016:Proportional Hazards Models D012189:Retrospective Studies D012720:Severity of Illness Index D015996:Survival Rate D013997:Time Factors D009927:Tissue and Organ Procurement D014481:United States D014850:Waiting Lists
share 35 policy liver transplantation united network for organ sharing NASH