Liver and Intestinal Organ Transplantation Committee Update Report
This report, presented by Dr. David Mulligan at the OPTN/UNOS Board of Directors Meeting in November 2014, discusses the strategic plan to increase access to transplants, focusing on liver transplantation prioritization based on need. Data from two eras show trends in deceased donor liver transplants, patient survival rates, and waiting list death rates. The report also highlights the recovery and utilization of livers for transplantation, providing valuable insights into transplantation practices.
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Liver and Intestinal Organ Transplantation Committee Update Report David Mulligan, MD, Chair OPTN/UNOS Board of Directors Meeting November 12-13, 2014
Share 15/35 / National LI-IN Share Analysis, 1-year Update
Strategic Plan Goal 2: To Increase Access to Transplants Under this policy, candidates most in need of liver transplantation are prioritized.
Data Data provided for 2 eras: June 18, 2012 June 17, 2013 (Pre-Era) June 18, 2013 June 17, 2014 (Post-Era) OPTN data as of August 22, 2014 Types of data National and some regional/DSA data focused on: Transplants by MELD/PELD, CIT, distance Post-transplant outcomes Waiting list mortality DSA imports/exports 9-month data presented in June 1-year updated abbreviated
Deceased Donor Liver Transplants by Era and Status/Allocation Score N=6029 N=6357 100% 6.1% 6.3% 90% 12.6% MELD/PELD Exceptions 18.7% 10.1% MELD/PELD Exceptions 26.3% 80% 70% % of Transplants 60% 50% 47.5% MELD/PELD exceptions 40% 51.6% MELD/PELD exceptions 73.1% 66.1% 30% 20% 10% 0% Pre-Era Post-Era < 15 15-34 35+ Status 1 Status or MELD/PELD Score Pre:6/18/2012-6/17/2013 Post:6/18/2013-6/17/2014
Livers Not Used Recovered for Transplant but Not Transplanted: 669 in Pre-Era (10.3 % of recovered) 653 in Post-Era (9.5% of recovered) Livers Not Recovered: 1149 in Pre-Era (14.1% of all donors) 1099 in Post-Era (13.0 % of all donors) Pre:6/18/2012-6/17/2013 Post:6/18/2013-6/17/2014
Six-Month Patient Survival Deceased Donor Liver Transplants Performed 120 Days Pre- and Post-Share 35 100 98 96 94 92 % Survival Pre-Era: All 90 Post Era: All 88 Pre Era: 35+ 86 Post Era: 35+ 84 82 80 1 2 3 4 5 6 Months Post-Transplant Pre:6/18/2012-6/17/2013 Post:6/18/2013-6/17/2014
Overall Liver Waiting List Death Rates: Deaths/Too Sick Per 100 Patient-Years Pre-Era Post-Era 18.9 20 18.8 18.5 18.5 18 No significant differences (Numbers of Deaths) 16 14 Deaths/100 PY 12 (2967) (2931) (3011) (2974) 8.9 10 8.7 8 6 4 (44) (43) 2 0 Adults Pediatrics Overall Pre:6/18/2012-6/17/2013 Post:6/18/2013-6/17/2014
MELD/PELD 35+ Waiting List Outcomes: Competing Risks Analysis N = 1998 N = 1720 Death Transplant Other Death Transplant Other 1 1 0.9 0.9 Transplant 0.58 Transplant* 0.66 0.8 0.8 0.7 0.7 Prob. of Outcome Prob. of Outcome 0.6 0.6 0.5 0.5 0.4 0.4 0.3 0.3 Death 0.32 0.2 0.2 Death* 0.24 0.1 0.1 0 0 0 15 30 45 60 75 90 0 15 30 45 60 75 90 Days Since Entry: Pre-Era Days Since Entry: Post-Era Pre:6/18/2012-6/17/2013 Post:6/18/2013-6/17/2014 *Transplant rate, Death Rate Significantly Different, p< 0.05
Summary: Post Share 35 Era Data Increased number/percent of MELD/35+ transplants Increased regional sharing No impact to overall waiting list mortality No impacts to waiting list mortality by age, ethnicity MELD/PELD 35+ waiting list candidates Increased transplant rate Decreased mortality rate
Summary: Post Share 35 Era Data Post-transplant survival (preliminary) No overall change No change to outcomes for MELD/PELD 35+ recipients No impact to overall liver discard rate Overall import/export dynamics similar to previous era
Thank you for your consideration. Questions? David C. Mulligan, MD Committee Chair David.Mulligan@yale.edu Ashley Archer-Hayes, MAS Committee Liaison Ashley.Archer-Hayes@unos.org
Median Allocation MELD/PELD at Transplant, by DSA within Region and Era Pre-Era Post-Era Variance across all DSAs = 14.3 Variance across all DSAs = 17.6 40 40 Median Match MELD @ Transplant 35 35 30 30 25 25 20 20 15 15 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 5 6 7 8 9 10 11 Region Region Pre:6/18/2012-6/17/2013 Post:6/18/2013-6/17/2014
Organ Travel Distance, Cold Ischemia Time, and Donor Risk Index Pre Post Median Distance organs traveled (miles) Overall: 59 85 Local: 22 23 Regional: 231 236 National: 687 660 Median Cold Ischemia Time (CIT) (hours) Overall: 6.1 6.1 Local: 5.9 5.8 Regional: 6.7 6.7 National: 8.1 7.7 Median Donor Risk Index (DRI) Overall: 1.4 1.3 1.5 1.6 1.4 1.3 1.4 1.7 Local: Regional : National: Pre:6/18/2012-6/17/2013 Post:6/18/2013-6/17/2014
