Lack of standardization in exception points for patients with primary sclerosing cholangitis and bacterial cholangitis.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
D GoldbergG Makar

Abstract

For conditions that the Model for End-Stage Liver Disease (MELD) score does not accurately predict waitlist mortality, transplant centers may apply to regional review boards for exception points. For patients with primary sclerosing cholangitis (PSC) suffering from bacterial cholangitis, consensus recommendations published in December 2006 are to grant exception points for recurrent cholangitis with ≥ 2 episodes of bacteremia or ≥ 1 episode septic complications. Using data provided by the United Network for Organ Sharing, we evaluated PSC patients who applied for exception points due to bacterial cholangitis from February 27, 2002 to March 14, 2011. Before publication of the recommendations, 66.0% of applications were accepted, compared with 80.1% after (p < 0.001). Focusing on applications after publication of the recommendations, 311 (74.6%) did not meet the recommended criteria, and 250 (80.4%) of these were approved. Of patients with approved applications, those not meeting consensus criteria were more likely to be transplanted, (77.4% vs. 62.8%, p = 0.043), whereas those with denied applications for approved indications were more liked to die/be removed (44.4% vs. 9.5%, p = 0.49). Although data are needed to properly ident...Continue Reading

References

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Citations

Dec 23, 2014·Current Transplantation Reports·David S Goldberg, Kim M Olthoff
Feb 19, 2013·Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association·David S Goldberg, Michael B Fallon
Nov 26, 2015·Clinics in Liver Disease·Vandana Khungar, David Seth Goldberg
Mar 1, 2013·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Russell H Wiesner
Dec 6, 2012·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·David S GoldbergK Rajender Reddy
Sep 17, 2013·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·David S GoldbergBenjamin French
Jan 20, 2015·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Richard C MadukaDavid S Goldberg
Jul 6, 2014·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·D S GoldbergM B Fallon
Apr 2, 2013·Clinics in Liver Disease·Andres F Carrion, Kalyan Ram Bhamidimarri
Apr 15, 2015·The American Journal of Gastroenterology·Keith D LindorUNKNOWN American College of Gastroenterology
Jan 18, 2017·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·David S Goldberg
Feb 7, 2019·Digestive Diseases and Sciences·Zachary P Fricker, David R Lichtenstein
Feb 20, 2020·Current Opinion in Organ Transplantation·Elizabeth S Aby, John R Lake
Mar 15, 2020·Journal of Clinical Medicine·Cătălina VlăduţMircea Diculescu
Nov 19, 2017·Transplant International : Official Journal of the European Society for Organ Transplantation·Jorn C GoetAnnemarie C de Vries
Mar 13, 2018·World Journal of Hepatology·Alberto FerrareseMarco Senzolo
Aug 25, 2017·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Joel P Wedd
Jun 4, 2020·Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen·Vittorio BranchiHanno Matthaei
Jun 3, 2015·World Journal of Gastroenterology : WJG·Yan-Hua LaiJia-Hong Dong
Jun 26, 2018·HPB : the Official Journal of the International Hepato Pancreato Biliary Association·Katharina StauferGabriela Berlakovich

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