Add like
Add dislike
Add to saved papers

Geographic disparity in deceased-donor liver transplant rates following Share 35.

Transplantation 2019 Februrary 20
BACKGROUND: The OPTN implemented Share35 on 6/18/2013 to broaden deceased-donor liver sharing within regional boundaries. We investigated whether increased sharing under Share35 impacted geographic disparity in deceased-donor liver transplantation (DDLT) across Donation Service Areas (DSAs).

METHODS: Using SRTR 6/2009-6/2017, we identified 86,083 adult LT candidates and retrospectively estimated MELD-adjusted DDLT rates using nested multilevel Poisson regression with random intercepts for DSA and transplant program. From the variance in DDLT rates across 49 DSAs and 102 programs, we derived the DSA-level median incidence rate ratio (MIRR) of DDLT rates. MIRR is a robust metric of heterogeneity across each hierarchical level; larger MIRR indicates greater disparity.

RESULTS: MIRR was 2.18 pre-Share35 and 2.16 post-Share35. Thus, two candidates with the same MELD in two different DSAs were expected to have a 2.2-fold difference in DDLT rate driven by geography alone. After accounting for program-level heterogeneity, MIRR was attenuated to 2.10 pre-Share35 and 1.96 post-Share35. For candidates with MELD 15-34, MIRR decreased from 2.51 pre- to 2.27 post-Share35, and for candidates with MELD 35-40, MIRR increased from 1.46 pre- to 1.51 post-Share35, independent of program-level heterogeneity in DDLT. DSA-level heterogeneity in DDLT rates was greater than program-level heterogeneity pre- and post-Share35.

CONCLUSIONS: Geographic disparity substantially impacted DDLT rates before and after Share35, independent of program-level heterogeneity and particularly for candidates with MELD 35-40. Despite broader sharing, geography remains a major determinant of access to deceased-donor liver transplantation.

Full text links

We have located links that may give you full text access.
Can't access the paper?
Try logging in through your university/institutional subscription. For a smoother one-click institutional access experience, please use our mobile app.

For the best experience, use the Read mobile app

Mobile app image

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app

All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

By using this service, you agree to our terms of use and privacy policy.

Your Privacy Choices Toggle icon

You can now claim free CME credits for this literature searchClaim now

Get seemless 1-tap access through your institution/university

For the best experience, use the Read mobile app