Impact of Share 35 liver transplantation allocation in Australia and New Zealand

Michael A Fink; Paul J Gow; Geoffrey W McCaughan; Peter Hodgkinson; John Chen; John McCall; Bryon Jaques; Michael Crawford; Simone I Strasser; Winita Hardikar; Mark Brooke-Smith; Graham Starkey; Gary P Jeffrey; Ed Gane; Michael Stormon; Helen Evans; Caroline Tallis; Amanda J Byrne; Robert M Jones

doi:10.1111/ctr.15203

Impact of Share 35 liver transplantation allocation in Australia and New Zealand

Clin Transplant. 2024 Jan;38(1):e15203. doi: 10.1111/ctr.15203. Epub 2023 Dec 13.

Authors

Michael A Fink^{1

2

3}, Paul J Gow², Geoffrey W McCaughan^{4

5

6}, Peter Hodgkinson⁷, John Chen⁸, John McCall^{9

10}, Bryon Jaques¹¹, Michael Crawford^{4

6}, Simone I Strasser^{4

6}, Winita Hardikar¹², Mark Brooke-Smith⁸, Graham Starkey², Gary P Jeffrey^{11

13}, Ed Gane^{9

10}, Michael Stormon^{4

14}, Helen Evans^{9

15}, Caroline Tallis⁷, Amanda J Byrne³, Robert M Jones^{1

2}

Affiliations

¹ Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia.
² Victorian Liver Transplant Unit, Austin Health, Melbourne, Victoria, Australia.
³ Australia and New Zealand Liver and Intestinal Transplant Registry, Melbourne, Australia.
⁴ University of Sydney, Sydney, New South Wales, Australia.
⁵ Liver Injury and Cancer, Centenary Institute, Camperdown, New South Wales, Australia.
⁶ Australian National Liver Transplant Unit, Royal Prince Alfred Hospital, Sydney, Australia.
⁷ Queensland Liver Transplant Service, Princess Alexandra Hospital and Queensland Children's Hospital, Brisbane, Australia.
⁸ Flinders Medical Centre, Adelaide, South Australia, Australia.
⁹ University of Auckland, Auckland, New Zealand.
¹⁰ New Zealand Liver Transplant Service, Auckland City Hospital, Auckland, New Zealand.
¹¹ Western Australian Liver Transplant Unit, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
¹² Gastroenterology and Clinical Nutrition Department Royal Children's Hospital, Melbourne, Victoria, Australia.
¹³ Medical School, The University of Western Australia, Perth, Western Australia, Australia.
¹⁴ Australian National Liver Transplantation Service, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
¹⁵ Department of Paediatric Gastroenterology, Starship Child Health, Auckland, New Zealand.

PMID: 38088459
DOI: 10.1111/ctr.15203

Abstract

Patients with high model for end-stage liver disease (MELD) scores waiting for liver transplantation in Australia and New Zealand (ANZ) have had limited access to deceased donor livers and therefore binational sharing of livers, for patients with a MELD score ≥35 was introduced in February 2016. Waiting list mortality, post-transplant outcomes and intention-to-treat survival were compared between patients whose MELD score reached 35 on the waiting list between October 2013 and April 2015 (Pre-Share 35 group, n = 23) and patients who were Share 35 listed between February 2016 and May 2022 (Share 35 group, n = 112). There was significantly reduced waiting list mortality in share 35 listed patients in comparison to the pre-Share 35 group (11.7% vs. 52.2%, OR .120 95% CI .044-.328, P < .001). Post-transplant patient and graft survival were not significantly different between the groups (5-year patient survival 82% vs. 84%, P = .991, 5-year graft survival 82% vs. 76%, P = .543). Intention-to-treat survival was superior in the Share 35 group (HR .302, 95% CI .149-.614, P < .001). Introduction of Share 35 in ANZ resulted in a 78% risk reduction in waiting list mortality, equivalent post-transplant survival and an improvement in intention-to-treat survival.

Keywords: end stage liver disease; graft survival; mortality; survival; waiting lists.

MeSH terms

End Stage Liver Disease* / surgery
Humans
Liver Transplantation*
New Zealand / epidemiology
Severity of Illness Index
Tissue and Organ Procurement*
Waiting Lists