Liver transplantation and waitlist mortality for HCC and non-HCC candidates following the 2015 HCC exception policy change

Tanveen Ishaque, Allan B Massie, Mary G. Bowring, Christine E. Haugen, Jessica M. Ruck, Samantha E. Halpern, Madeleine M. Waldram, Macey Henderson, Jacqueline Garonzik, Andrew M Cameron, Benjamin Philosophe, Shane Ottmann, Anne Rositch, Dorry Segev

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalAmerican Journal of Transplantation
DOIs
StateAccepted/In press - Jan 1 2018

Keywords

  • cancer/malignancy/neoplasia
  • clinical research/practice
  • disparities
  • graft survival
  • liver disease: malignant
  • liver transplantation/hepatology
  • organ allocation

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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