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

D. Goldberg, T. Bittermann, G. Makar

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

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 identify those patients at highest risk for waitlist mortality, standardized criteria or a centralized review board should be adopted to ensure consistency in the granting of exception points. Despite consensus recommendations being published in December of 2006, the overwhelming majority of exception point applications submitted to and accepted by regional review boards, among patients with primary sclerosing cholangitis suffering from bacterial cholangitis, do not meet the published clinical criteria for receipt of exception points for this condition.

Original languageEnglish (US)
Pages (from-to)1603-1609
Number of pages7
JournalAmerican Journal of Transplantation
Volume12
Issue number6
DOIs
StatePublished - Jun 2012
Externally publishedYes

Keywords

  • Bacterial cholangitis
  • exception points
  • primary sclerosing cholangitis
  • regional review boards

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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