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Liver transplantation and waitlist mortality for HCC and non‐ HCC candidates following the 2015 HCC exception policy change
Author(s) -
Ishaque Tanveen,
Massie Allan B.,
Bowring Mary G.,
Haugen Christine E.,
Ruck Jessica M.,
Halpern Samantha E.,
Waldram Madeleine M.,
Henderson Macey L.,
Garonzik Wang Jacqueline M.,
Cameron Andrew M.,
Philosophe Benjamin,
Ottmann Shane,
Rositch Anne F.,
Segev Dorry L.
Publication year - 2019
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15144
Subject(s) - medicine , hepatocellular carcinoma , liver transplantation , context (archaeology) , liver disease , proportional hazards model , liver cancer , oncology , transplantation , gastroenterology , biology , paleontology
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 (as HR = 0.54 0.63 0.73 ) and a comparable risk of mortality/dropout postpolicy (as HR = 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.