Excess waitlist mortality among candidates for multivisceral liver-intestine transplant in acuity circle allocation.

Autor:	Kwong AJ; Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California, USA. Electronic address: ajk@stanford.edu., Schnellinger E; United Network for Organ Sharing, Richmond, Virginia, USA., Foutz J; United Network for Organ Sharing, Richmond, Virginia, USA., Cafarella M; United Network for Organ Sharing, Richmond, Virginia, USA., Nagai S; Henry Ford Health, Detroit, Michigan, USA., Biggins SW; University of Pittsburgh, Pittsburgh, Pennsylvania, USA., Pomposelli J; University of Colorado Anschutz Medical Center, Aurora, Colorado, USA., Trotter J; Baylor University Medical Center, Baylor Scott and White Health, Dallas, Texas, USA.
Jazyk:	angličtina
Zdroj:	American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2024 Jun; Vol. 24 (6), pp. 1080-1086. Date of Electronic Publication: 2024 Feb 24.
DOI:	10.1016/j.ajt.2024.02.021
Abstrakt:	Candidates for multivisceral transplant (MVT) have experienced decreased access to transplant in recent years. Using Organ Procurement and Transplantation Network data, transplant and waiting list outcomes for MVT (ie, liver-intestine, liver-intestine-pancreas, and liver-intestine-kidney-pancreas) candidates listed between February 4, 2018, and February 3, 2022, were analyzed, including model for end-stage liver disease/pediatric end-stage liver disease and exception scores by era (before and after acuity circle [AC] implementation on February 4, 2020) and age group (pediatric and adult). Of 284 MVT waitlist registrations (45.6% pediatric), fewer had exception points at listing post-AC compared to pre-AC (10.0% vs 19.1%), and they were less likely to receive transplant (19.1% vs 35.9% at 90 days; 35.7% vs 57.2% at 1 year). Of 177 MVT recipients, exception points at transplant were more common post-AC compared to pre-AC (30.8% vs 20.2%). Postpolicy, adult MVT candidates were more likely to be removed due to death/too sick compared with liver-alone candidates (13.5% vs 5.6% at 90 days; 24.2% vs 9.8% at 1 year), whereas no excess waitlist mortality was observed among pediatric MVT candidates. Under current allocation policy, multivisceral candidates experience inferior waitlist outcomes compared with liver-alone candidates. Clarification of guidance around submission and approval of multivisceral exception requests may help improve their access to transplantation and achieve equity between multivisceral and liver-alone candidates on the liver transplant waiting list. (Copyright © 2024 American Society of Transplantation & American Society of Transplant Surgeons. All rights reserved.)
Databáze:	MEDLINE
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