The effects of Share 35 on the cost of liver transplantation

Berumen, Jennifer; Misel, Michael; Vodkin, Irine; Halldorson, Jeffrey B.; Mekeel, Kristin L.; Hemming, Alan W.

doi:10.1111/ctr.12937

Cited by 10 publications

(11 citation statements)

References 22 publications

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“…The increase in LDLT volume has been variable across the United States, with most cases occurring in regions with high‐median MELD scores, perhaps reflecting regional differences in patient demand and institution LDLT experience 28 . The impact of Share 35 on resource use and hospital costs undoubtedly varies by region, and future studies should include analyses of how increased LDLT may offset the costs of both waiting for LT and transplanting patients with MELD scores > 35 29,30 . Finally, national advocacy and standardization of best practices in LT may reduce regional variation and help mitigate resource use without impacting outcomes.…”

Section: Discussionmentioning

confidence: 99%

Outcomes and resource use for liver transplantation in the United States: Insights from the 2009‐2017 National Inpatient Sample

Aguayo

Hadaya

Nakhla

et al. 2021

Clinical Transplantation

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Introduction Liver transplantation (LT) is a life‐saving treatment for end‐stage liver disease patients that requires significant resources. We used national data to evaluate LT outcomes and factors associated with hospital resource use. Methods Using the National Inpatient Sample, we identified all patients undergoing LT from 2009 to 2017 and defined high‐resource use (HRU) as having costs ≥ 90th percentile. Hierarchical regression models were used to assess factors associated with length of stay (LOS) and HRU. Results Over the study period, approximately 53,000 patients underwent LT, increasing from 5,582 in 2009 to 7,095 in 2017 (nptrend < 0.001). Morbidity and mortality were 42.2% and 3.9%, respectively, with a median post‐LT LOS of 10 days. Hospitalization costs increased from $106,866 to $145,868 (nptrend < 0.001). Acute kidney injury (β:4.7 days, P < .001) and end‐stage renal disease (ESRD) with dialysis (β:4.3 days, P < .001) were associated with greater LOS while the Northeast region (AOR:5.2, P < .001), ESRD with dialysis (AOR:3.4, P < .001), heart failure (AOR:2.5, P < .001), and fulminant liver disease (AOR:1.8, P = .01) were associated with HRU. Conclusion The cost of LT has increased over time. Renal dysfunction, regional practice patterns, and patient acuity were associated with greater resource use. Transplanting patients before health deterioration may help contain costs, mitigate resource use, and improve LT outcomes.

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Section: Discussionmentioning

confidence: 99%

Outcomes and resource use for liver transplantation in the United States: Insights from the 2009‐2017 National Inpatient Sample

Aguayo

Hadaya

Nakhla

et al. 2021

Clinical Transplantation

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“…Interestingly, the Share 35 policy also improved graft and patient survival in recipients with either MELD score ≥40 or re-transplantation [ 9 , 10 ]. Berumen et al showed that the cost of treatment for liver transplantation increased after Share 35 policy implementation [ 11 ]. Even though many studies about the Share 35 policy have been published, there is scanty research on intraoperative management for higher medical acuity liver transplantation recipients after implementation of the policy.…”

Section: Discussionmentioning

confidence: 99%

Impact of the Share 35 Policy on Perioperative Management and Mortality in Liver Transplantation Recipients

2021

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Background The Share 35 policy was introduced in 2013 by the Organ Procurement and Transplantation Network (OPTN) to increase opportunities of sicker patients to access liver transplantation. However, it has the disadvantage of higher MELD score associated with adverse postoperative transplant outcomes. Early data after implementation of the Share 35 policy showed significantly poorer post-transplantation survival in some UNOS regions. We aimed to analyze the impact of Share 35 on demographics of patients, perioperative management, and perioperative mortality. Material/Methods A retrospective analysis of data was performed from an institutional liver transplantation cohort from 1 January 2008 to 31 December 2017. Adult patients who underwent liver transplantation before 2013 were defined as the pre-Share 35 group and the other group was defined as the post-Share 35 group. The MELD score of each patient was calculated at the time of transplantation. Perioperative mortality was defined as death within 30 days after the operation. Results A total of 1596 patients underwent liver transplantation. Of those, 895 recipients underwent OLT in the pre-Share 35 era and 737 in the post-Share 35 era. The median MELD score was significantly higher in the post-Share 35 group (30 vs 26, P <0.001) and 45.7% of the post-Share 35 group had MELD scores ≥35. In intraoperative management, patients required significantly more blood component transfusion, intraoperative vasopressor, and fluid replacement. Veno-venous bypass (VVB) usage was significantly higher in the post-Share 35 era (47.2% vs 38.1%, P <0.001). In the subgroup of patients with MELD scores ≥35, the median waiting time was significantly shorter (18.5 vs 14.5 days, P =0.045). Overall perioperative mortality was not significantly difference between groups ( P =0.435). Conclusions After implementation of the Share 35 policy, we performed liver transplantation in significantly higher medical acuity patients, which required more medical resources to obtain a result comparable to that of the pre-Share 35 era.

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“…18,19 Share 35 has generally not had a negative impact on transplant outcomes although some studies have demonstrated increased mortality in waiting list patients with HCC, higher costs, and increased organ turndown rates for patients with MELD > 35. [20][21][22] However, these studies excluded reLTx recipients. This analysis focused on reLTx recipients to investigate whether the Share35 policy was advantageous for this cohort.…”

Section: Discussionmentioning

confidence: 99%