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The Evolution of the National Liver Review Board

S. Noreen1, J. Trotter2, J. Pomposelli3, M. Cafarella1, J. Heimbach4

1UNOS, Richmond, VA, 2BSWHealth, Dallas, TX, 3UCHealth, Aurora, CO, 4Mayo Clinic, Rochester, MN

Meeting: 2021 American Transplant Congress

Abstract number: 106

Keywords: Liver, Liver transplantation, Public policy, Waiting lists

Topic: Clinical Science » Public Policy » Non-Organ Specific: Public Policy & Allocation

Session Information

Session Name: Potpourri of Public Policy and Allocation

Session Type: Rapid Fire Oral Abstract

Date: Sunday, June 6, 2021

Session Time: 4:30pm-5:30pm

 Presentation Time: 4:45pm-4:50pm

Location: Virtual

*Purpose: The National Liver Review Board (NLRB) was implemented 5/14/2019, establishing a national structure for liver exceptions comprised of three specialty review boards and a scoring system based on the median score for the area of distribution. The area of distribution was revised with the implementation of Acuity Circles (AC) on 2/4/2020. The OPTN Liver Committee has been closely evaluating this policy.

*Methods: OPTN exception requests and liver waitlist (WL) registrations data during 8/21/2018-5/13/2019 (RRB era), 5/14/2019-2/03/2020 (pre-AC NLRB era), and 2/04-10/26/2020 (post-AC NLRB era) were used, as well as snapshots of the WL each month from 8/2019 – 10/2020. OPTN transplant data was used for deceased donor liver-alone transplants, divided into RRB (8/21/2018-3/18/2019), pre-AC NLRB (5/14-12/09/2019), and post-AC NLRB (2/04-8/31/2020) eras. Chi-square and Kruskal-Wallis tests assessed differences between eras.

*Results: The proportion of auto-approvals significantly increased over the study period (38% post-AC NLRB, 31% pre-AC NLRB, 24% RRB eras, p<0.001). Time for reviewers to resolve cases in the post-AC NLRB era continued to decrease over time (average 4.4 days post-AC NLRB, 5.1 pre-AC NLRB, 5.8 RRB eras, p<0.001). WL dropout rates increased for exception candidates, with similar rates for non-HCC exceptions and non-exceptions post-AC NLRB era, and the relationship between non-exception and HCC exception transplant rates has reversed (Figure 1). There was a decrease in the proportion of exceptions on the WL and transplants (Figure 2).

*Conclusions: More exception forms continue to be automatically approved, decreasing the burden on reviewers. Reviewers also continue to resolve cases quicker. Exception candidate priority relative to non-exception candidates has begun to decrease, particularly for HCC exception candidates, and this has allowed non-exception candidates with higher medical urgency to receive transplants while driving down the scores at which exception candidates access transplant.

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To cite this abstract in AMA style:

Noreen S, Trotter J, Pomposelli J, Cafarella M, Heimbach J. The Evolution of the National Liver Review Board [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/the-evolution-of-the-national-liver-review-board/. Accessed June 2, 2025.

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