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Impact of Regional Organ Sharing and Allocation in the UK Northern Liver Alliance on Waiting Time to Liver Transplantation and Waitlist Survival

Malik, Abdullah K. MB, ChB, MRes1; Masson, Steven FRCP1; Allen, Elisa PhD2; Akyol, Murat MD3; Bathgate, Andrew MD3; Davies, Mervyn MD4; Hidalgo, Ernest PhD4; Hudson, Mark FRCP1; Powell, James MD3; Taylor, Rhiannon MSc2; Zarankaite, Agne MSc2; Manas, Derek M. MD1 on behalf of the UK Northern Liver Alliance

doi: 10.1097/TP.0000000000002687
Original Clinical Science–Liver

Background. In the United Kingdom, liver transplantation (LT) is undertaken in 7 supraregional centers. Until March 2018, liver grafts were offered to a center and allocated to a patient on their elective waiting list (WL) based on unit prioritization. Patients in Newcastle, Leeds, and Edinburgh with a United Kingdom Model for End-Stage Liver Disease (UKELD) score ≥62 were registered on a common WL and prioritized for deceased-donor liver allocation. This was known as the Northern Liver Alliance (NLA) “top-band scheme.” Organs were shared between the 3 centers, with a “payback” scheme ensuring no patient in any center was disadvantaged. We investigated whether the NLA had improved WL survival and waiting time (WT) to transplantation.

Methods. Data for this study were obtained from the UK Transplant Registry maintained by National Health Service Blood and Transplant. This study was based on adult patients registered for first elective liver transplant between April 2013 and December 2016. Non-NLA centers were controls. The Kaplan-Meier method was used to estimate WL survival and median WT to transplant, with the log-rank test used to make comparisons; a Bonferroni correction was applied post hoc to determine pairwise differences.

Results. WT was significantly lower at NLA centers compared with non-NLA centers for top-band patients (23 versus 99 days, P < 0.001). However, WL survival was not significantly different for top-band patients (P > 0.999) comparing NLA with non-NLA centers. WL survival for nontop-band patients was no different (P > 0.999) comparing NLA with non-NLA centers.

Conclusions. The NLA achieved its aim, providing earlier transplantation to patients with the greatest need. Nontop-band patients did not experience inferior survival.

1 Liver Transplant Unit, Freeman Hospital, Newcastle upon Tyne, United Kingdom.

2 Statistics and Clinical Studies, NHS Blood and Transplant, Stoke Gifford, Bristol, United Kingdom.

3 Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Scotland, United Kingdom.

4 Leeds Transplant Unit, St James’s University Hospital, Leeds, United Kingdom.

Received 20 August 2018. Revision received 14 January 2019.

Accepted 8 February 2019.

A.K.M. contributed to data analysis, research design, and cowrote the manuscript. S.M. contributed to data analysis, research design, and cowrote the manuscript. E.A., R.T., and A.Z. performed data analysis and statistical analysis and contributed to the revision of the manuscript. M.A., A.B., M.D., E.H., M.H., and J.P. contributed to the performance of the study and revision of the manuscript. D.M.M. contributed to research design, performance of the study, and critical revision of the manuscript.

The authors declare no conflicts of interest.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

Correspondence: Dr Steven Masson, FRCP, Liver Unit, Freeman Hospital, Newcastle upon Tyne NE7 7DN, United Kingdom. (

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