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Liver Transplant HCC exeption points REVISED 10/8/2015

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Posted 10/3/2015 4:01 PM (GMT 0)
I know many here have been transplanted with a low biologic MELD score, but granted exception pts due to HCC. How do you feel about this policy change?

"Revised liver policy regarding HCC exception scores

Revisions to OPTN liver allocation policy will be implemented on October 8, 2015, modifying the maximum value of exception scores for candidates with hepatocellular carcinoma (HCC) and the timing of exception scores assigned to HCC candidates.
The revised policy, approved by the OPTN/UNOS Board of Directors in November 2014, is intended to create a better balance in transplant opportunities between candidates with HCC exceptions and those with allocation priority based on their calculated MELD/PELD score. It will not change the data fields required to support the application for an exception score.

The maximum HCC exception score will be capped at 34 for any candidates with an exception application submitted on or after October 8. If a candidate has an accumulated HCC exception score of 35 or higher at the time the new policy is implemented, their exception score will be reset to 34 for the duration of their time with an HCC exception as long as they continue to meet criteria. Candidates may be referred to the Regional Review Board (RRB) if they demonstrate the need for higher priority.

The revised policy also establishes a new timetable that delays assignment of new or extended HCC exception scores. For any new HCC exception applications submitted on or after October 8, candidates must be registered at their calculated MELD or PELD scores for the first three months (initial application) and for the first three-month extension, as long as the candidate continues to meet the policy criteria. At six months (second extension), MELD candidates will receive a score of 28, and PELD candidates will receive a score of 34.

For the wording of the revised policy and additional information about the rationale for the policy, read the December 2014 policy notice."


Here are some frequently asked questions:

optn.transplant.hrsa.gov/news/revised-liver-policy-regarding-hcc-exception-scores/#faq



Discuss! Big Hugs
Posted 10/3/2015 4:39 PM (GMT 0)
This raised the first exception approval to MELD 28.

In 2011, the first exception approval, while sooner than 6 months, was only 22 and then escalated each 3 months....so by the 6th month, Mike's MELD would have been 28...the same. His tumor was recognized in Feb, his MELD went up soon after and he was transplanted in May...so he was up to 25 at that point.

Do they still deny at a certain tumor size? I think 5cm (or mm?).

It seems like folks with rapidly growing tumors would wind up out of the system.

Some get radio frequency ablation with HCC to decrease the size of the tumor (not a cure really I don't think), would that negatively affect their MELD score? I didn't read the FAQs but will go back and do that now.

Thanks themiz for keeping on top of this important change.

Hugs,


ML

confused confused
Posted 10/3/2015 5:45 PM (GMT 0)
The new cap, MELD 34, will keep the HCC folks out of the SHARE 35 program. We know in some regions a MELD 34 is not going to get a transplant. Those with HCC and a biological low MELD may want (need) to relocate to be transplanted ( ie: NY, MA, CA). This is a big change for those folks. On the other hand, those who are critically ill with a biological MELD 35 will now have less competition for SHARE 35 livers. Share 35....interesting info:

/www.transplantpro.org/wp-content/uploads/sites/3/14-Share-35_Edwards.pdf

/www.transplantpro.org/wp-content/uploads/sites/3/16-Impact-on-OPOs_Levy.pdf



Where was Mike's biological MELD when transplanted? Many people get very ill, (like MIKE), tuned-up, and find their MELD drops. I have very mixed feelings about this new policy revision.
Posted 10/3/2015 7:43 PM (GMT 0)
I went to Mike's Notebooks, there are 5 of them now, 3 inch loose leaf books with labs, hospital reports, procedures, MRIs, etc.

His biological MELD in October 2009 was 26 after his hospitalization for Sepsis, Hep C, Acute Kidney failure, and Alcoholic Liver disease.

Sober, on all the meds they give you, and lots of bedrest, his MELD was 19 in February 2011 plus the tumor points. Which brought him to 22 and then 25 I think, but my mind is fuzzy on some things.

I don't find labs for dates in between...he was transplanted May 1, 2011.

He was so very ill for all that time 2009 - 2011, I can't believe he lived through it.

And I know you are going through that at your house...hugs to both of you.

Some of this stuff is pretty technical but interesting even so. One gets to feel like a dot on a chart...it is hard to feel very positive about the % of better scores for those over 35 when your own loved one is deathly ill and in the mid teens. How do those with 35s even get out of bed???

Hugs,
ML
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