studies

HEPATOLOGY, VOLUME 62, NUMBER 1 (SUPPL) AASLD ABSTRACTS 241A
approaches that inhibit Hh signaling down-regulate YAP, profibrogenic
YAP targets and aSMA, showing that Hh regulates
YAP and suggesting that YAP may be a downstream effector of
pro-EMT Hh signaling.
Disclosures:
The following authors have nothing to disclose: Marzena Swiderska-Syn, Wing-
Kin Syn, Guanhua Xie, Mark Jewell, Richard T. Premont, Gregory A. Michelotti,
Anna Mae Diehl
67
Region-Based Projections of Deceased Liver Donors from
2015-2025: An Analysis of Proposed UNOS Liver Allocation
Redistricting
Neehar D. Parikh 1 , Wesley J. Marrero Colon 2 , Yongcai Xu 2 , Anna
S. Lok 1 , David W. Hutton 3 , Mariel S. Lavieri 2 ; 1 Division of Gastroenterology,
University of Michigan, Ann Arbor, MI; 2 Industrial and
Operations Engineering, University of Michigan, Ann Arbor, MI;
3 School of Public Health, University of Michigan, Ann Arbor, MI
Background: To help remedy the geographic disparity in liver
transplant (LT) allocation the United Network of Organ Sharing
(UNOS) has recently proposed regional redistricting plans.
While current geographic inequity will improve, it is unclear to
what extent demographic trends in the US will impact redistricting.
We aimed to determine the impact of population demographic
trends on liver redistricting proposals. Method: We
performed a secondary analysis of the Organ Procurement
and Transplantation Network database of all adult donors from
2000 to 2012 and calculated the total number of donors available
and transplanted donor livers stratified by age, race, and
body mass index (BMI) group per year. We used National
Health and Nutrition Examination Survey and Centers for Disease
Control and Prevention historical data to stratify the US
population by age, sex, race, and BMI. We then used US population
age and race projections provided by the US Census
Bureau and the Weldon Cooper Center for Public Service and
made regional projections of available donors from 2015 to
2025, incorporating the proposed 8- and 4-region redistricting
plans proposed by UNOS. Given the uncertainty in LT demand,
we used donors/100,000 population age 18-84 (D/100K) as
a measure of equity. We calculated the mean and variation
between regions, by calculating the percentage difference
between the highest and lowest D/100K per allocation model.
Results: The overall projected D/100K will decrease from 2.72
to 2.65 over the next decade. The projected percentage variation
in 2015 and 2025 in each model is shown in the Table.
In the current 11-region allocation system, the 2015 range in
D/100K is 2.45-2.89, and is projected to be 2.42-2.83 in
2025. In the proposed 8-region allocation system the 2015
range is 2.49-2.89, and is projected to be 2.42-2.83 in 2025.
In the 4-region allocation system, the 2015 range is 2.49-2.79
and is projected to be 2.42-2.71 in 2025. Conclusions: Of
the current UNOS allocation schemes, the 4-region allocation
model reduces the geographic variation to the greatest extent.
This is projected to be maintained as the US population ages
and undergoes demographic shifts over the next decade. However,
this should be balanced by consequences of redistricting
such as increased cold ischemia time and costs associated with
organ transport.
68
Liver transplantation waiting list mortality in PSC
patients is low as compared to non-PSC patients and
consistent across laboratory MELD and MELD exception
candidates: a nationwide study in the Netherlands
Annemarie C. de Vries 1 , Madelon Tieleman 1 , Bart van Hoek 2 ,
Aad P. van den Berg 3 , Wojciech G. Polak 4 , Jan Ringers 5 , Robert J.
Porte 6 , Cynthia Konijn 7 , Robert A. de Man 1 , Henk R. van Buuren 1 ,
Bettina E. Hansen 1 , Herold J. Metselaar 1 ; 1 Gastroenterology and
Hepatology, Erasmus MC University Medical Center, Rotterdam,
Netherlands; 2 Gastroenterology and Hepatology, Leiden University
Medical Center, Leiden, Netherlands; 3 Gastroenterology and
Hepatology, University Medical Center Groningen, Groningen,
Netherlands; 4 Surgery, Erasmus MC University Medical Center,
Rotterdam, Netherlands; 5 Surgery, Leiden University Medical
Center, Leiden, Netherlands; 6 Surgery, University Medical Center
Groningen, Groningen, Netherlands; 7 Dutch Transplantation Foundation,
Leiden, Netherlands
Background: PSC patients with end-stage disease form a heterogeneous
group due to their varying complications. This
hinders laboratory MELD score prioritization on the liver transplantation
(LTx) waiting list, resulting in both lab MELD (LM)
and MELD exception (ME) PSC candidates. Aim: To assess LTx
waiting list mortality of LM and ME PSC candidates as compared
to non-PSC patients. Methods: Patients aged ≥18 years
who were listed for LTx in the Netherlands after introduction of
the MELD score prioritization to December 31th 2013 were
included. Data were recorded until November 2014. Exclusion
criteria were reLTx, HU status or combined organ transplantation.
A competing risk analysis was performed. Results: During
the study period 852 candidates (M 579/ F 273; median age
54.0 yrs) were listed for LTx. Median lab MELD score at listing
was not significantly different between PSC patients (n=146)
and non-PSC patients (n=706) (13.5 vs. 13.0; p=0.51).
ME points were granted in resp. 22 PSC and 227 non-PSC
patients (HR 0.34; p