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Liver transplantation wait list may overprioritize some patients with hepatopulmonary syndrome
Some patients with hepatopulmonary syndrome who were prioritized on the national wait list for liver transplantation had lower post-transplant mortality than other transplant patients, suggesting that the exception policy should be reassessed, according to recent study data.
Investigator David S. Goldberg, MD, MSCE, at the Perelman School of Medicine, University of Pennsylvania, and colleagues conducted a retrospective cohort study of 973 patients on the liver transplantation waiting list who received exception points and priority status based on MELD score for having hepatopulmonary syndrome (HPS). All data, submitted to the United Network for Organ Sharing (UNOS) between February 2002 and December 2012, evaluated room-air oxygenation effects on pre- and post-transplant mortality among HPS patients.
David S. Goldberg
“We examined the relationship between patients’ blood oxygen levels and outcomes in … patients who received HPS exception points, and compared survival in HPS vs. non-HPS patients,” Goldberg said in a press release.
Although no associations were observed between oxygenation and wait list mortality among HPS patients with exception points, pre-transplant recipients with greater hypoxemia had an increased risk for death after transplantation. In patients with PaO2levels of 44.1 to 54 mm Hg, unadjusted 3-year rates of survival were 83.6% (95% CI, 77.4-88.2) compared with 68.1% (95% CI, 52.9-79.4) for patients with levels no greater than 44 mm Hg.
Researchers said 20% of non-HPS wait list patients died while awaiting transplantation or within 90 days of wait list removal vs. HPS patients (9%; P<.001), while 73% of HPS patients with exception points received transplants compared with 43% of non-HPS candidates (P<.001).
“HPS [MELD] exception patients had lower overall mortality compared with others awaiting liver transplantation, suggesting that the appropriateness of the HPS exception policy should be reassessed,” the investigators wrote.
“These data, we hope, can provide some guidance to UNOS, as the exception point policy comes under revision,” Goldberg said. “We want to make it easier for the patients in the most urgent need to be prioritized as such, according to evidence-based criteria.”
Disclosure: The researchers report no relevant financial disclosures.