Who Survives the Waiting for a new Liver

Liver cancer patients more likely to receive organ transplants

(RxWiki News) Liver transplants are sometimes the only answer for people suffering from either cancer or other life-threatening liver diseases. 

People with liver cancer - hepatocellular carcinoma (HCC) - are more likely to get a liver organ transplant than folks who do not have cancer.

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A scoring system has been in place since 2002 to prioritize candidates on waiting lists for liver transplants. Implemented by the United Network for Organ Sharing (UNOS), this system is called the Model for End Stage Liver Disease (MELD).

MELD predicts who on the list is at risk of dying within 90 days. People with greater clinical risks receive what are known as MELD exception points.

People with HCC can receive up to 22 exception points, which puts them ahead of patients who are actually at greater risk of dying.

"With the scarcity of available livers for transplantation, it is vital that allocation criteria ensure those candidates at greatest mortality risk are first to receive a life-saving organ," said Dr. David Goldberg with the University of Pennsylvania and lead author of the current study.

"Our study investigated appropriate designation of exception points for transplant candidates with HCC, comparing mortality risk to those with similar MELD scores, but without liver cancer."

Researchers examined data gathered from the Organ Procurement and Transplantation Network on candidates 18 years and older who were on waiting lists for liver transplants between January 2005 and May 2009.

A total of 6,246 candidates received exception points for stage II liver cancer. These people tended to be older Caucasian or Asian men.

In sifting through all the numbers, researchers found that people with liver cancer were far less likely to be removed from the waiting list due to clinical deterioration or death than people with non-cancer liver disease.

Dr. Goldberg concludes, "Our data suggest HCC candidates have substantially lower odds of waitlist removal for death or deterioration than non-HCC candidates, and strongly indicates that exception points currently allotted for HCC should be lowered."

In an accompanying editorial, Dr. Patrick Northup from the University of Virginia writes, "The allocation system should be managed as a whole, rather than as isolated pieces, to ensure patients on the waitlist are prioritized based on the desire to minimize waitlist mortality."

The research and editorial were published in the April, 2012 issue of Liver Transplantation.