The effect of Share 35 on biliary complications: An interrupted time series analysis

• Published in: American journal of transplantation Vol. 19; no. 1; pp. 221 - 226
• Main Authors: Fleming, J. N., Taber, D. J., Axelrod, D., Chavin, K. D.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.01.2019
• Subjects: Adolescent; Adult; Aged; disparities; donors and donation: deceased; End Stage Liver Disease - mortality; Female; Geography; Health Policy; health services and outcomes research; Health Status Disparities; Healthcare Disparities; Hospital Mortality; Humans; Interrupted Time Series Analysis; Length of Stay; Liver; Liver - surgery; Liver transplantation; Liver Transplantation - mortality; liver transplantation/hepatology; Liver transplants; Male; Middle Aged; Mortality; organ allocation; organ procurement and allocation; registry/registry analysis; Reproducibility of Results; Time series; Tissue and Organ Procurement - legislation & jurisprudence; Tissue and Organ Procurement - methods; Tissue Donors; Transplants & implants; United States; Waiting Lists; Young Adult; United States; disparities; registry/registry analysis; organ procurement and allocation; donors and donation: deceased; organ allocation; liver transplantation/hepatology; health services and outcomes research
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.14937

The purpose of the Share 35 allocation policy was to improve liver transplant waitlist mortality, targeting high MELD waitlisted patients. However, policy changes may also have unintended consequences that must be balanced with the primary desired outcome. We performed an interrupted time series assessing the impact of Share 35 on biliary complications in a select national liver transplant population using the Vizient CDB/RM database. Liver transplants that occurred between October 2012 and September 2015 were included. There was a significant change in the incident‐rate of biliary complications between Pre‐Share 35 (n = 3018) and Post‐Share 35 (n = 9984) cohorts over time (P = .023, r2 = .44). As a control, a subanalysis was performed throughout the same time period in Region 9 transplant centers, where a broad sharing agreement had previously been implemented. In the subanalysis, there was no change in the incident‐rate of biliary complications between the two time periods. Length of stay and mean direct cost demonstrated a change after implementation of Share 35, although they did not meet statistical difference. While the target of improved waitlist mortality is of utmost importance for the equitable allocation of organs, unintended consequences of policy changes should be studied for a full assessment of a policy's impact. In an interrupted time series analysis in a national liver transplant population, the authors find a significant increase in the incident‐rate of in‐hospital biliary complication claims since the implementation of the national allocation policy.