Douglas R. Murken, Allison W. Peng, David D. Aufhauser, Peter L. Abt, David S. Goldberg, Matthew H. Levine

Early studies of national data suggest that the Share 35 allocation policy increased liver transplants without compromising post-transplant outcomes. Changes in center-specific volumes and practice patterns in response to the national policy change are not well characterized. Understanding center-level responses to Share 35 is crucial for optimizing the policy and constructing effective future policy revisions. Data from the United Network for Organ Sharing were analyzed to compare center-level volumes of allocation-MELD ≥35 transplants pre- and post-policy implementation. There was significant center-level variation in the number and proportion of allocation-MELD ≥35 transplants performed from the pre- to post-Share 35 period; eight centers accounted for 33.7% of the total national increase in allocation-MELD ≥35 transplants performed in the 2.5-year post-Share 35 period, while 25 centers accounted for 65.0% of the national increase. This trend correlated with increased listing at these centers of patients with MELD ≥35 at the time of initial listing. These centers did not over-represent the total national volume of liver transplants. Comparison of post-Share 35 allocation-MELD to calculated time-of-transplant laboratory MELD showed that only 69.6% of patients transplanted with allocation-MELD ≥35 maintained a calculated laboratory MELD ≥35 at the time-of-transplant. Share 35 increased transplantation of allocation-MELD ≥35 recipients on a national level, but the policy asymmetrically impacted practice patterns and volumes of a subset of centers. Longer-term data is necessary to assess outcomes at centers with markedly increased volumes of high-MELD transplants post-Share 35. This article is protected by copyright. All rights reserved.