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

J N Fleming; D J Taber; D Axelrod; K D Chavin

doi:10.1111/ajt.14937

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

Journal article

Open access

Peer reviewed

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

J N Fleming, D J Taber, D Axelrod and K D Chavin

American journal of transplantation, Vol.19(1), pp.221-226

01/2019

DOI: 10.1111/ajt.14937

PMID: 29767478

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https://doi.org/10.1111/ajt.14937View

Published (Version of record) Open Access

Abstract

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, r = .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.

Adolescent

Adult

Aged

End Stage Liver Disease - mortality

Female

Geography

Health Policy

Health Status Disparities

Healthcare Disparities

Hospital Mortality

Humans

Interrupted Time Series Analysis

Length of Stay

Liver - surgery

Liver Transplantation - mortality

Male

Middle Aged

Reproducibility of Results

Tissue and Organ Procurement - legislation & jurisprudence

Tissue and Organ Procurement - methods

Tissue Donors

United States

Waiting Lists

Young Adult

Details

Title: Subtitle: The effect of Share 35 on biliary complications: An interrupted time series analysis
Creators: J N Fleming - Medical University of South Carolina
D J Taber - Medical University of South Carolina
D Axelrod - Lahey Medical Center
K D Chavin - University Hospitals of Cleveland
Resource Type: Journal article
Publication Details: American journal of transplantation, Vol.19(1), pp.221-226
DOI: 10.1111/ajt.14937
PMID: 29767478
NLM abbreviation: Am J Transplant
ISSN: 1600-6135
eISSN: 1600-6143
Language: English
Date published: 01/2019
Academic Unit: Surgery
Record Identifier: 9984322938902771

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3 Times Cited - Web of Science