Exception points for liver transplantation: A Canadian review.
allocation
eMELD
ePELD
health policy
Journal
Canadian liver journal
ISSN: 2561-4444
Titre abrégé: Can Liver J
Pays: Canada
ID NLM: 101778326
Informations de publication
Date de publication:
Jul 2023
Jul 2023
Historique:
received:
05
09
2022
accepted:
11
09
2022
medline:
28
7
2023
pubmed:
28
7
2023
entrez:
28
7
2023
Statut:
epublish
Résumé
Exception points for liver transplant (LT) allocation are used to account for mortality risk not reflected by scoring systems such as the Model for End-Stage Liver Disease with sodium (MELD-Na). Currently, there is no formal policy regarding exception points in Canada, and differences across the country are not well understood. As such, a review of the criteria and exception points granted throughout the country for LT was conducted. Seven LT centres in five provinces were surveyed (Vancouver, Edmonton, London, Toronto, Montréal, Halifax) regarding the indications and criteria for exception points granted, the number of points granted, how points would be accrued, and the maximum points granted. Programs in British Columbia and Nova Scotia grant variable exception points based on the median MELD-Na score with modifications; Alberta, Ontario, and Quebec grant exception points using specific values based on the indication. Overall, there was significant heterogeneity regarding exception points granted nationally with agreement only for awarding exception points for hepatopulmonary syndrome and polycystic liver disease. The second most common agreed-upon indications for exception points were portopulmonary hypertension and recurrent cholangitis offered by four provinces. Quebec had the most formal criteria for non-cirrhosis-based conditions. There is substantial variance across the country regarding the indications for granting exception points as well as the number of points granted. Future work on developing a national consensus will be important for the development of equity in LT across Canada.
Sections du résumé
Background
UNASSIGNED
Exception points for liver transplant (LT) allocation are used to account for mortality risk not reflected by scoring systems such as the Model for End-Stage Liver Disease with sodium (MELD-Na). Currently, there is no formal policy regarding exception points in Canada, and differences across the country are not well understood. As such, a review of the criteria and exception points granted throughout the country for LT was conducted.
Methods
UNASSIGNED
Seven LT centres in five provinces were surveyed (Vancouver, Edmonton, London, Toronto, Montréal, Halifax) regarding the indications and criteria for exception points granted, the number of points granted, how points would be accrued, and the maximum points granted.
Results
UNASSIGNED
Programs in British Columbia and Nova Scotia grant variable exception points based on the median MELD-Na score with modifications; Alberta, Ontario, and Quebec grant exception points using specific values based on the indication. Overall, there was significant heterogeneity regarding exception points granted nationally with agreement only for awarding exception points for hepatopulmonary syndrome and polycystic liver disease. The second most common agreed-upon indications for exception points were portopulmonary hypertension and recurrent cholangitis offered by four provinces. Quebec had the most formal criteria for non-cirrhosis-based conditions.
Conclusions
UNASSIGNED
There is substantial variance across the country regarding the indications for granting exception points as well as the number of points granted. Future work on developing a national consensus will be important for the development of equity in LT across Canada.
Identifiants
pubmed: 37503519
doi: 10.3138/canlivj-2022-0026
pmc: PMC10370721
doi:
Types de publication
Journal Article
Langues
eng
Pagination
201-214Informations de copyright
© Canadian Association for the Study of the Liver, 2023.
Références
HPB (Oxford). 2022 Jul;24(7):1168-1176
pubmed: 35065891
CMAJ Open. 2019 Mar 29;7(1):E182-E189
pubmed: 30926602
J Clin Gastroenterol. 2022 Nov-Dec 01;56(10):902-907
pubmed: 34802021
Am J Transplant. 2022 Mar;22 Suppl 2:204-309
pubmed: 35266621
World J Methodol. 2022 Jan 20;12(1):32-42
pubmed: 35117980
Am J Transplant. 2012 Jun;12(6):1603-9
pubmed: 22335632
Liver Transpl. 2006 Dec;12(12 Suppl 3):S128-36
pubmed: 17123284
Pharmacoepidemiol Drug Saf. 2013 Jan;22(1):103-7
pubmed: 23124932
Curr Transplant Rep. 2014 Dec 1;1(4):232-237
pubmed: 25530936
J Hepatol. 2019 Nov;71(5):1058-1060
pubmed: 31495534
Can J Gastroenterol Hepatol. 2016;2016:1329532
pubmed: 27446823
JAMA Pediatr. 2018 Nov 1;172(11):1070-1077
pubmed: 30242345
Can Liver J. 2020 Nov 17;3(4):372-380
pubmed: 35990508
Am J Transplant. 2021 Jan;21(1):222-228
pubmed: 32306489