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Abstract
Candidates for multivisceral transplant (MVT) have experienced decreased access to transplant in recent years. Using OPTN data, transplant and waiting list outcomes for MVT (i.e., liver-intestine, liver-intestine-pancreas, and liver-intestine-kidney-pancreas) candidates listed 2/4/2018-2/3/2022 were analyzed, including MELD/PELD and exception scores by era (before and after acuity circle [AC] implementation 2/4/2020) and age group (pediatric and adult). Of 284 MVT waitlist registrations (45.6% pediatric), fewer had exception points at listing post-AC compared to pre-AC (10.0% vs. 19.1%), and they were less likely to receive transplant (19.1% vs. 35.9% at 90 days; 35.7% vs. 57.2% at 1 year). Of 177 MVT recipients, exception points at transplant were more common post-AC compared to pre-AC (30.8% vs. 20.2%). Post-policy, adult MVT candidates were more likely to be removed due to death/too sick compared to liver-alone candidates (13.5% v. 5.6% at 90 days; 24.2% v. 9.8% at 1 year), whereas no excess waitlist mortality was observed among pediatric MVT candidates. Under current allocation policy, multivisceral candidates experience inferior waitlist outcomes compared to liver-alone candidates. Clarification of guidance around submission and approval of multivisceral exception requests may help improve their access to transplantation and achieve equity between multivisceral and liver-alone candidates on the liver transplant waiting list.
View details for DOI 10.1016/j.ajt.2024.02.021
View details for PubMedID 38408641