Monitoring reports address liver transplant initiatives
Published on: Monday, March 24, 2025
Two recent Organ Procurement and Transplantation Network (OPTN) data reports address activities and outcomes related to the work of the OPTN Liver and Intestinal Organ Transplantation Committee.
One report reviews two years of experience under a policy that bases the median MELD at transplant (MMaT) score on the location of the donor hospital where the liver was recovered. Compared to a two-year period before policy implementation, the report notes several key observations:
- Liver transplant rates increased in the post-policy era, both overall by the type of liver exception and for nearly all OPTN Regions.
- The number of liver transplant registrations, as well as waiting list removals due to death or becoming too sick for transplant, remained constant across the policy eras.
- For exception candidates receiving a liver transplant, the median allocation MELD score increased slightly from the pre-policy to post-policy timeframe.
- In addition to the policy change, guidance was published for liver transplant programs to use in seeking exceptions for candidates with ischemic cholangiopathy or polycystic liver disease. While there are fewer candidates with these conditions as compared to other diagnoses leading to an exception score, the guidance resulted in increases in median allocation score and decreases in variation among allocation scores, consistent with expected performance outcomes.
A second report monitors individual effects of changes to policy, guidelines or guidance for seven different actions relating to the National Liver Review Board (NLRB). These included the establishment of a pediatric appeals review team for exception requests related to pediatric candidates, as well as updated guidance for pediatric candidates. The other changes addressed criteria for diagnoses including:
- Portopulmonary hypertension
- Polycystic liver disease
- Hilar cholangiocarcinoma
- Neuroendocrine tumors
- Primary and secondary sclerosing cholangitis
Since the changes addressed different aspects and were implemented on different dates in 2021, each topic is addressed individually in the report with supporting data and narrative.
While no further policy monitoring reports are planned regarding the MMaT surrounding the donor hospital, the OPTN Liver and Intestinal Organ Transplantation Committee continually reviews data on liver allocation policy performance to guide future policy development.