Early Impact of MMaT-3 Policy on Liver Transplant Waitlist Outcomes for Hepatocellular Carcinoma.
Early Impact of MMaT-3 Policy on Liver Transplant Waitlist Outcomes for Hepatocellular Carcinoma.
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DOI：
10.1097/txd.0000000000001313
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发表时间：
2022-05
影响因子：
2.3
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中科院分区：
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为了减少获得肝移植（LT）的差距，器官共享联合网络于2019年5月实施了一项例外政策，该政策将供体服务区域内移植的肝细胞癌（HCC）例外评分限制为终末期肝病模型（MELD）中位数，在6个月的等待期后减去3分（MMaT-3）。我们的目的是评估这一政策如何影响HCC等候名单的结果。使用联合器官共享网络的数据，我们分析了MMaT前时代（2017年8月15日至2018年11月15日）和MMaT时代（2019年6月1日至2020年8月30日）HCC患者在获得例外点时的等待名单结果。在MMaT前和MMaT时代的HCC组和HCC与非HCC组（上市时）之间进行比较，并根据MMaT将区域分为低、中、高MELD。HCC组：HCC患者的LT概率在两个时期之间下降了20%（亚危险比[sHR]， 0.78； 95%可信区间[CI]， 0.74-0.85），在低MELD区域下降了41% （sHR, 0.59; 95% CI, 0.52-0.66）。候补名单上的辍学率没有变化。匹配的HCC组与非HCC组：在mmat前，HCC患者的LT概率比非HCC患者高80% (sHR, 1.84; 95% CI, 1.71-1.99)；在MMaT时代，LT概率下降到14%。在低、中区域，HCC患者在MMaT前的LT概率高出两倍以上，而在MMaT时代HCC患者的LT概率下降至20%左右（sHR, 1.14; 95% CI, 1.06-1.23）。实施视度圈政策后，HCC患者的LT概率低于非HCC患者（sHR, 0.84; 95% CI, 0.74-0.94）。HCC和非HCC患者之间的地理差异在MMaT-3政策下得到了改善。尽管HCC患者的肝移植概率较低，但退出候补名单并未受到不利影响。
To reduce the disparity in access to liver transplant (LT), United Network for Organ Sharing implemented an exception policy in May 2019, which capped hepatocellular carcinoma (HCC) exception score to the median Model for End-Stage Liver Disease (MELD) at transplant within the donor service area minus 3 points (MMaT-3) after the 6-mo wait period. We aimed to evaluate how this policy affected HCC waitlist outcomes. Using United Network for Organ Sharing data, we analyzed waitlist outcomes in HCC patients at the time they received exception points from in the pre-MMaT era (August 15, 2017, to November 15, 2018) and MMaT era (June 1, 2019, to August 30, 2020). Comparisons were made within the HCC group and HCC versus non-HCC (at time of listing) groups in the pre-MMaT and MMaT eras and regions were grouped as low, medium, and high MELD based on MMaT. HCC group: LT probability within HCC patients decreased by 20% (subhazard ratio [sHR], 0.78; 95% confidence interval [CI], 0.74-0.85) between the eras and decreased by 41% in low MELD regions (sHR, 0.59; 95% CI, 0.52-0.66). Waitlist dropout was unchanged. Matched HCC versus non-HCC groups: HCC patients had 80% higher LT probability (sHR, 1.84; 95% CI, 1.71-1.99) than non-HCC patients in the pre-MMaT era; which decreased to a 14% higher LT probability in MMaT era. In low and medium regions, HCC patients had over twofold higher LT probability in the pre-MMaT era, which decreased to a ~20% higher probability (sHR, 1.14; 95% CI, 1.06-1.23) in the MMaT era. After implementation of the acuity circle policy, HCC patients had lower LT probability (sHR, 0.84; 95% CI, 0.74-0.94) than non-HCC patients. The geographic disparity between HCC and non-HCC patients has improved with the MMaT-3 policy. Despite lower LT probability for HCC patients, waitlist dropout was not adversely impacted.