Life expectancy without a transplant for status 1A liver transplant candidates

Area of Science:

• Transplant medicine
• Organ allocation policy
• Biostatistics

Background:

• Status 1A designation grants the highest priority for deceased donor liver allocation.
• Organ Procurement and Transplantation Network (OPTN) policy mandates a life expectancy of less than 7 days without a transplant for 1A status.
• Specific medical conditions are required for 1A status eligibility.

Purpose of the Study:

• To evaluate the actual life expectancy of status 1A liver transplant candidates.
• To compare observed life expectancy with the OPTN policy requirement of <7 days.
• To assess if subgroups of 1A candidates meet the policy's life expectancy criteria.

Main Methods:

• Utilized data from the Scientific Registry of Transplant Recipients (2010-2020).
• Employed a bias-corrected Kaplan-Meier model to estimate survival and life expectancy.
• Analyzed overall status 1A candidates and specific subgroups based on qualifying medical conditions.

Main Results:

• Status 1A liver transplant candidates have an estimated life expectancy of 24 days without a transplant (95% CI 20-46).
• This observed life expectancy is more than three times the 7-day threshold set by OPTN policy.
• No subgroup of 1A candidates, based on their medical conditions, met the <7-day life expectancy requirement.

Conclusions:

• Current OPTN policy for status 1A liver transplant candidates is not aligned with observed patient data.
• Observed life expectancy for 1A candidates significantly exceeds the policy's <7-day requirement.
• Harmonizing OPTN policy with empirical data is crucial for maintaining the integrity of liver allocation.