TY - JOUR
T1 - Liver transplantation and waitlist mortality for HCC and non-HCC candidates following the 2015 HCC exception policy change
AU - Ishaque, Tanveen
AU - Massie, Allan B.
AU - Bowring, Mary G.
AU - Haugen, Christine E.
AU - Ruck, Jessica M.
AU - Halpern, Samantha E.
AU - Waldram, Madeleine M.
AU - Henderson, Macey L.
AU - Garonzik Wang, Jacqueline M.
AU - Cameron, Andrew M.
AU - Philosophe, Benjamin
AU - Ottmann, Shane
AU - Rositch, Anne F.
AU - Segev, Dorry L.
N1 - Funding Information:
Funding for this study was provided by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK): grant numbers K24DK101828 (PI: Segev), K01DK101677 (PI: Massie) and K01DK114388 (PI: Henderson); and the National Institute on Aging: F32AG053025 (PI: Haugen). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the U.S. government. The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. government.
Publisher Copyright:
© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2019/2
Y1 - 2019/2
N2 - Historically, exception points for hepatocellular carcinoma (HCC) led to higher transplant rates and lower waitlist mortality for HCC candidates compared to non-HCC candidates. As of October 2015, HCC candidates must wait 6 months after initial application to obtain exception points; the impact of this policy remains unstudied. Using 2013-2017 SRTR data, we identified 39 350 adult, first-time, active waitlist candidates and compared deceased donor liver transplant (DDLT) rates and waitlist mortality/dropout for HCC versus non-HCC candidates before (October 8, 2013-October 7, 2015, prepolicy) and after (October 8, 2015-October 7, 2017, postpolicy) the policy change using Cox and competing risks regression, respectively. Compared to non-HCC candidates with the same calculated MELD, HCC candidates had a 3.6-fold higher rate of DDLT prepolicy (aHR = 3.49 3.69 3.89) and a 2.2-fold higher rate of DDLT postpolicy (aHR = 2.09 2.21 2.34). Compared to non-HCC candidates with the same allocation priority, HCC candidates had a 37% lower risk of waitlist mortality/dropout prepolicy (asHR = 0.54 0.63 0.73) and a comparable risk of mortality/dropout postpolicy (asHR = 0.81 0.95 1.11). Following the policy change, the DDLT advantage for HCC candidates remained, albeit dramatically attenuated, without any substantial increase in waitlist mortality/dropout. In the context of sickest-first liver allocation, the revised policy seems to have established allocation equity for HCC and non-HCC candidates.
AB - Historically, exception points for hepatocellular carcinoma (HCC) led to higher transplant rates and lower waitlist mortality for HCC candidates compared to non-HCC candidates. As of October 2015, HCC candidates must wait 6 months after initial application to obtain exception points; the impact of this policy remains unstudied. Using 2013-2017 SRTR data, we identified 39 350 adult, first-time, active waitlist candidates and compared deceased donor liver transplant (DDLT) rates and waitlist mortality/dropout for HCC versus non-HCC candidates before (October 8, 2013-October 7, 2015, prepolicy) and after (October 8, 2015-October 7, 2017, postpolicy) the policy change using Cox and competing risks regression, respectively. Compared to non-HCC candidates with the same calculated MELD, HCC candidates had a 3.6-fold higher rate of DDLT prepolicy (aHR = 3.49 3.69 3.89) and a 2.2-fold higher rate of DDLT postpolicy (aHR = 2.09 2.21 2.34). Compared to non-HCC candidates with the same allocation priority, HCC candidates had a 37% lower risk of waitlist mortality/dropout prepolicy (asHR = 0.54 0.63 0.73) and a comparable risk of mortality/dropout postpolicy (asHR = 0.81 0.95 1.11). Following the policy change, the DDLT advantage for HCC candidates remained, albeit dramatically attenuated, without any substantial increase in waitlist mortality/dropout. In the context of sickest-first liver allocation, the revised policy seems to have established allocation equity for HCC and non-HCC candidates.
KW - cancer/malignancy/neoplasia
KW - clinical research/practice
KW - disparities
KW - graft survival
KW - liver disease: malignant
KW - liver transplantation/hepatology
KW - organ allocation
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U2 - 10.1111/ajt.15144
DO - 10.1111/ajt.15144
M3 - Article
C2 - 30312530
AN - SCOPUS:85056317651
SN - 1600-6135
VL - 19
SP - 564
EP - 572
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 2
ER -