Early Impact of MMaT-3 Policy on Liver Transplant Waitlist Outcomes for Hepatocellular Carcinoma

Autor: Anjiya Shaikh, MBBS, Karthik Goli, BS, Nicole E. Rich, MD, Jihane N. Benhammou, MD, PhD, Saira Khaderi, MD, PhD, Ruben Hernaez, MD, PhD, Vatche G. Agopian, MD, John M. Vierling, MD, Donghee Kim, MD, PhD, Aijaz Ahmed, MD, John A. Goss, MD, Abbas Rana, MD, Fasiha Kanwal, MD, MSHS, George Cholankeril, MD, MSECR,
Jazyk: angličtina
Rok vydání: 2022
Předmět:
Zdroj: Transplantation Direct, Vol 8, Iss 5, p e1313 (2022)
Druh dokumentu: article
ISSN: 2373-8731
00000000
DOI: 10.1097/TXD.0000000000001313
Popis: Background. To reduce the disparity in access to liver transplant (LT), United Network for Organ Sharing implemented an exception policy in May 2019, which capped hepatocellular carcinoma (HCC) exception score to the median Model for End-Stage Liver Disease (MELD) at transplant within the donor service area minus 3 points (MMaT-3) after the 6-mo wait period. We aimed to evaluate how this policy affected HCC waitlist outcomes. Methods. Using United Network for Organ Sharing data, we analyzed waitlist outcomes in HCC patients at the time they received exception points from in the pre-MMaT era (August 15, 2017, to November 15, 2018) and MMaT era (June 1, 2019, to August 30, 2020). Comparisons were made within the HCC group and HCC versus non-HCC (at time of listing) groups in the pre-MMaT and MMaT eras and regions were grouped as low, medium, and high MELD based on MMaT. Results. HCC group: LT probability within HCC patients decreased by 20% (subhazard ratio [sHR], 0.78; 95% confidence interval [CI], 0.74-0.85) between the eras and decreased by 41% in low MELD regions (sHR, 0.59; 95% CI, 0.52-0.66). Waitlist dropout was unchanged. Matched HCC versus non-HCC groups: HCC patients had 80% higher LT probability (sHR, 1.84; 95% CI, 1.71-1.99) than non-HCC patients in the pre-MMaT era; which decreased to a 14% higher LT probability in MMaT era. In low and medium regions, HCC patients had over twofold higher LT probability in the pre-MMaT era, which decreased to a ~20% higher probability (sHR, 1.14; 95% CI, 1.06-1.23) in the MMaT era. After implementation of the acuity circle policy, HCC patients had lower LT probability (sHR, 0.84; 95% CI, 0.74-0.94) than non-HCC patients. Conclusions. The geographic disparity between HCC and non-HCC patients has improved with the MMaT-3 policy. Despite lower LT probability for HCC patients, waitlist dropout was not adversely impacted.
Databáze: Directory of Open Access Journals
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