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Geographic disparity in deceased donor liver transplant for hepatocellular carcinoma after introduction of acuity circle liver transplantation policy
Hepatology ; 74(SUPPL 1):846A, 2021.
Article in English | EMBASE | ID: covidwho-1508772
ABSTRACT

Background:

Liver transplant is an important curative option for select patients with hepatocellular carcinoma (HCC). The acuity circles-based allocation in February 2021 and a change setting model for end stage liver disease (MELD) exception points for HCC to the regional median MELD minus three, have the potential to create a difference in transplant opportunity for HCC patients despite having the same disease. We analyzed the effect of allocation changes on deceased donor liver transplant (DDLTs) for HCC in various regions of the US.

Methods:

Characteristics of HCC and non-HCC DDLTs in the year before (2/4/2019-2/3/2020) and after (2/4/2020-2/4/2021) introduction of the acuity circle policy were assessed using the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) database. Based on the median national MELD at transplant of 28, OPTN regions were stratified into low (≤28) and high (>28) MELD regions. We performed chi-squared proportional testing to compare differences in transplant volumes in both eras.

Results:

In the pre-acuity circle era there were 6699 DDLTs performed compared to 6660 DDLTs in the post-acuity circle area era (-0.6%). The 0.6% decrease in the number of DDLTs was driven entirely by a decrease in DDLTs for HCC (1529 to 1351;-11.6%) (Figure 1). There was a reduction in the absolute numbers of HCC transplants performed in most regions. There were statistically significant decreases in regions 2 (-37.8%, p<0.001) and 4 (-28.3%, p=0.001) and a numerical decrease in region 11 (-20.3% p=0.088), all low MELD regions. Conversely, there were absolute increases in DDLTs for HCC in region 9 (+17.6%, p=0.388), region 1 (+3.0%, p=0.875), and region 5 (+1.6%, p=0.811), all high MELD regions. To assess if the reduction in HCC transplants was attributable to the COVID-19 pandemic, we examined changes in the proportion of all DDLT being performed for HCC. Similar to the changes in the absolute number of DDLTs, the overall percentage of DDLTs performed for HCC decreased after the new allocation system nationally (22.8% to 20.3%) with statistically significant decreases in regions 2 (26.5% to 18.3%, p<0.001) and 4 (27.8% to 20.5%, p=0.001).

Conclusion:

After introduction of new organ allocation policies in early 2020, there were large shifts in regional sharing of organs and statistically significant decreases in DDLT for HCC both nationally and in low MELD regions. The COVID-19 pandemic-related changes are unlikely to account for disproportionate decreases in HCC transplants. Ongoing investigation of these trends are needed to ensure that HCC patients are not unfairly disadvantaged because of geographic differences in score allocation for the same disease.

Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Hepatology Year: 2021 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Hepatology Year: 2021 Document Type: Article