Effective Jan. 5, updated guidance is in place regarding the National Liver Review Board (NLRB) consideration of pediatric candidates with cystic fibrosis, as well as candidates with hepatic adenomas or Budd-Chiari Syndrome. The OPTN Board of Directors approved the new guidance at its December 2022 meeting as part of enhancements to the NLRB.
Liver transplant program staff should familiarize themselves with the changes. Some transplant candidates may be newly eligible for an exception, or their qualifying criteria may change.
For pediatric liver-alone transplant candidates with cystic fibrosis, the guidance for pediatric exceptions establishes a new pathway to a MELD or PELD exception for those meeting the following criteria:
- Candidates who have portal hypertension with complications and have failed or are not candidates for medical, endoscopic or surgical interventions to prevent or treat these complications.
- Candidates who have growth failure as a result of their liver disease, defined by age and sex-specific weight, length/height, weight-for-length, and/or body mass index (BMI) percentiles or have moderate to severe malnutrition.
- Candidates who have a forced expiratory volume at 1 second (FEV1) less than 70% or evidence of decline in FEV1 of greater than or equal to 5% per year.
The guidance for adult MELD exceptions other than HCC has been updated for the following conditions:
- For adult transplant candidates with hepatic adenomas, the guidance removes an unnecessary introductory paragraph, updates the criteria to better identify candidates needing a MELD exception, and removes references to “multiple” hepatic adenomas.
- For candidates with Budd-Chiari Syndrome, the guidance removes an unnecessary introductory paragraph, adds failed surgical management as a qualifying criterion, and removes the requirement for programs to provide etiology of hypercoagulable state. It also removes the criterion related to decompensated hepatic hydrothorax requiring thoracentesis, which is already covered in guidance for hepatic hydrothorax.
