Liver transplantation after share 35: Impact on pretransplant and posttransplant costs and mortality

Share 35 was implemented in 2013 to direct livers to the most urgent candidates by prioritizing Model for End-Stage Liver Disease (MELD) ≥ 35 patients. We aim to evaluate this policy's impact on costs and mortality. Our study includes 834 wait-listed patients and 338 patients who received deceased donor, solitary liver transplants at Mayo Clinic between January 2010 and December 2014. Of these patients, 101 (30%) underwent transplantation after Share 35. After Share 35, 29 (28. 7%) MELD ≥ 35 patients received transplants, as opposed to 46 (19. 4%) in the pre-Share 35 era (P = 0. 06). No significant difference in 90-day wait-list mortality (P = 0. 29) nor 365-day posttransplant mortality (P = 0. 68) was found between patients transplanted before or after Share 35. Mean costs were 3, 049 (P = 0. 30), 5226 (P = 0. 18), and 10, 826 (P = 0. 03) lower post-Share 35 for the 30-, 90-, and 365-day pretransplant periods, and mean costs were 5010 (P = 0. 41) and 5859 (P = 0. 57) higher, and 9145 (P = 0. 54) lower post-Share 35 for the 30-, 90-, and 365-day posttransplant periods. In conclusion, the added cost of transplanting more MELD ≥ 35 patients may be offset by pretransplant care cost reduction. Despite shifting organs to critically ill patients, Share 35 has not impacted mortality significantly. Liver Transplantation 23: 11-18 2017 AASLD.