Introduction: Liver transplant units in Australia and New Zealand (ANZ) have a long history of cooperation, including sharing of deceased donor livers for transplantation between units, in order to minimise the risk of waiting list mortality and maximise the utility of donated organs. Organ sharing between units occurs in the following circumstances: category 1, acute liver failure, intubated; category 2, predominantly for acute liver failure, not intubated; Share 35, patients with a model for end-stage liver disease (MELD) score ≥ 35; and non-urgent, in circumstances when the local unit declines the donor offer.
The outcomes of deceased donor liver sharing in ANZ were analysed.
Materials and Methods: The ANZ Liver and Intestinal Transplant Registry was analysed for outcomes of organ sharing for category 1, category 2, Share 35 and non-urgent patients.
Results: There were 133 category 1 listings from 2010-2019. Eleven (8%) died waiting. Patient survival at 1, 5 and 10 years was 81%, 78% and 78%, respectively. Graft survival at 1, 5 and 10 years was 79%, 76% and 76%, respectively. There was no significant difference in patient or graft survival between transplants performed using imported and local grafts (P=0.117 and P=0.101, respectively).
There were 139 category 2 listings from 2010-2019. Two (1%) died waiting. Patient survival at 1, 5 and 9 years was 90%, 90% and 90%, respectively. Graft survival at 1, 5 and 10 years was 87%, 87% and 85%, respectively. There was no significant difference in patient or graft survival between transplants performed using imported and local grafts (P=0.190 and P=0.162, respectively).
There were 55 Share 35 listings from February 2016 (when this category was introduced) to December 2019. Forty-eight patients were transplanted (26 with an imported liver and 22 with a local liver). Seven (13%) patients died waiting. The waiting list mortality was significantly less than that of a comparable patient population prior to the introduction of Share 35 (October 2013-April 2015, 48%, P=0.0009). Patient and graft survival were 84% and 74%, respectively at 1 year and 80% and 70%, respectively at 3 years, which was not significantly different to patient and graft survival prior to the introduction of Share 35 (86% and 86%, respectively at 1year and 86% and 86%, respectively at 3 years, P=0.709 for patient survival and P=0.309 for graft survival).
There was no difference in patient or graft survival in non-urgent patients transplanted with imported (n=321) or local (n=2261) livers (P=0.707 and P=0.715, respectively).
Conclusion: Sharing of deceased donor livers between centres in ANZ for urgent patients resulted in low waiting list mortality and good utility. The introduction of Share 35 has resulted in a reduction in waiting list mortality and satisfactory post-transplant survival for patients with a MELD score ≥ 35.  Non-urgent transplantation of shipped organs has similar outcomes to that performed with non-shipped organs.