Updated National Liver Review Board guidance now in effect

Published on: Wednesday, July 27, 2022

Effective July 26, updated guidance is in place regarding the National Liver Review Board (NLRB) consideration of candidates with polycystic liver disease (PLD), ischemic cholangiopathy (IC), and hepatocellular carcinoma (HCC). The OPTN Board of Directors approved the new guidance at its June 2022 meeting as part of enhancements to the NLRB.

The guidance regarding adult MELD exceptions for hepatocellular carcinoma (HCC) has been simplified for candidates who have HCC that recurred after treatment. The changes will provide a more consistent and equitable pathway for these candidates to receive a MELD exception.

The guidance for adult MELD exceptions other than HCC has been updated for two medical conditions:

• Ischemic Cholangiopathy (IC): Candidates meeting criteria for an exception are recommended to be provided a score equal to median MELD at transplant (MMaT). Because IC is a complication associated with livers from donation after cardiac death (DCD) donors, this change will allow these candidates to access retransplant more quickly.
• Polycystic Liver Disease (PLD): The revised guidance provides a more objective definition for moderate to severe protein calorie malnutrition, adds sarcopenia as a qualifying comorbidity, removes unnecessary language, and recommends all candidates meeting criteria be considered for MMaT. These changes will ensure that the appropriate candidates are able to access an exception and will increase equity in access to transplant for all PLD candidates.

Note: In the same set of actions approving the updated guidance, the OPTN Board also approved policy updates relating to HCC candidates. These policy updates will go into effect at a later date, and liver transplant programs will be separately notified in advance of that implementation.