Abstract:
|
To address the disparity in transplantation access between hepatocellular carcinoma (HCC) and non-HCC patients, the United Network for Organ Sharing (UNOS) recently implemented a six-month delay before granting exception points to liver transplant candidates with HCC. As an alternative to the six-month delay, an HCC-specific scoring scheme called the Model for End-Stage Liver Disease Equivalent (MELDEQ) has also been developed. To assess which prioritization scheme would result in more equitable outcomes, we compared projected dropout and transplant probabilities for HCC and non-HCC patients under the six-month delay and the MELDEQ using causal inference and multistate modeling methods with recent UNOS data. Projections under the MELDEQ and the six-month delay were similar during the first six months on the waitlist. However, reverting back to scheduled exception point progression after six months still advantaged HCC patients. Projections under the MELDEQ for patients on the waitlist after six months showed more equitable transplant probabilities and decreased dropout for non-HCC patients, but increased dropout for HCC patients with MELDEQ scores < 22.
|