ATC Abstracts

American Transplant Congress abstracts

  • Home
  • Meetings Archive
    • 2020 American Transplant Congress
    • 2019 American Transplant Congress
    • 2018 American Transplant Congress
    • 2017 American Transplant Congress
    • 2016 American Transplant Congress
    • 2015 American Transplant Congress
    • 2013 American Transplant Congress
  • Keyword Index
  • Resources
    • 2016 Resources
      • 2016 Welcome Letter
      • ATC 2016 Program Planning Committees
      • ASTS Council 2015-2016
      • AST Board of Directors 2015-2016
    • 2015 Resources
      • 2015 Welcome Letter
      • ATC 2015 Program Planning Committees
      • ASTS Council 2014-2015
      • AST Board of Directors 2014-2015
      • 2015 Conference Schedule
  • Advanced Search

The Impact of CMS Policy on Delisting of "Too Sick" Liver Transplant Candidates.

N. Dolgin, B. Movahedi, P. Martins, A. Bozorgzadeh.

Surgery, UMass Medical School, Worcester, MA.

Meeting: 2016 American Transplant Congress

Abstract number: 446

Keywords: High-risk, Liver transplantation, Public policy, Waiting lists

Session Information

Date: Tuesday, June 14, 2016

Session Name: Concurrent Session: Liver: MELD, Allocation and Donor Issues (DCD/ECD) 1

Session Time: 2:30pm-4:00pm

 Presentation Time: 3:42pm-3:54pm

Location: Room 304

Related Abstracts
  • Assessing the Impact of the Share35 Liver Allocation Policy: Survival Outcomes Among Liver Re-Transplant Recipients.
  • Significant Increase in Wait List Removals for Candidates Considered Too Sick from the US Kidney Transplant Waiting List.

Background: The Model for End Stage Liver Disease (MELD)-based allocation system (2002) transformed liver transplant waitlist mortality by prioritizing the “sickest first.” We examine the extent to which removal of the “sickest” patients on the liver transplant waitlist is associated with the 2007 regulatory CMS policy, “Conditions of Participation (COP).”

Study Design: We used UNOS/SRTR to identify 90,765 US adults (≥18 years of age) on deceased donor liver transplant waiting lists at 102 transplant centers from April 2002 to December 2012. We used interrupted time series regression analysis to quantify national trends in the incidence of candidate delisting due to illness severity (“too sick to transplant” or “medically unsuitable”) pre-post COP implementation (June 28, 2007).

Results: We observed increasing trends in delisting due to illness severity in the setting of comparable demographic and clinical characteristics pre-post COP implementation. The incidence of delisting abruptly increased by 16% at the time of COP implementation and the likelihood of being delisted continued to increase by approximately 3% per quarter thereafter (p<0.001). COP did not impact 1-year post-transplant mortality trends (p=0.38).

Conclusions: CMS “Conditions of Participation” implementation critically altered candidate selection for liver transplantation in 2007. Meaningful improvement in post-transplant survival, at the societal cost of removing increasingly more of the sickest patients, was not observed. Policy-makers and clinicians should consider population-level survival in the design of performance measures and in clinical decision-making.

  Level Change Trend Change
  Incidence Rate Ratio (p-value) Incidence Rate Ratio (p-value)
"Too Sick" Waitlist Removal 1.16 (<0.001) 1.01 (<0.001)
Death <1 Year After Transplant 0.99 (0.62) 1.00 (0.38)

CITATION INFORMATION: Dolgin N, Movahedi B, Martins P, Bozorgzadeh A. The Impact of CMS Policy on Delisting of "Too Sick" Liver Transplant Candidates. Am J Transplant. 2016;16 (suppl 3).

  • Tweet
  • Email
  • Print

To cite this abstract in AMA style:

Dolgin N, Movahedi B, Martins P, Bozorgzadeh A. The Impact of CMS Policy on Delisting of "Too Sick" Liver Transplant Candidates. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/the-impact-of-cms-policy-on-delisting-of-too-sick-liver-transplant-candidates/. Accessed March 2, 2021.

« Back to 2016 American Transplant Congress

Most Viewed Abstracts

  • This Week
  • This Month
  • All Time
  • Low GFR after Kidney Donation Is Not Chronic Kidney Disease
  • Subtherapeutic Low Tacrolimus Trough Levels (≤3.5 Ng /ml) Are A Risk Factor For Acute Rejection And Creatinine Doubling.
  • Is There a Difference Between DCD and DBD Kidney Transplantation with Similar KDPI?
  • Kidney Dialysis after Heart Transplantation: The Short and Long Term Outcomes
  • Penis Transplantation: First U.S. Experience.
  • Low GFR after Kidney Donation Is Not Chronic Kidney Disease
  • Subtherapeutic Low Tacrolimus Trough Levels (≤3.5 Ng /ml) Are A Risk Factor For Acute Rejection And Creatinine Doubling.
  • Penis Transplantation: First U.S. Experience.
  • A Decade of Donor-Derived Disease: A Report of the OPTN Ad Hoc Disease Transmission Advisory Committee (DTAC).
  • Is There a Difference Between DCD and DBD Kidney Transplantation with Similar KDPI?
  • Penis Transplantation: First U.S. Experience.
  • Is There a Difference Between DCD and DBD Kidney Transplantation with Similar KDPI?
  • Low GFR after Kidney Donation Is Not Chronic Kidney Disease
  • Evidence of a Clinically Significant Drug-Drug Interaction between Cannabidiol and Tacrolimus: A Case Report
  • Kidney Dialysis after Heart Transplantation: The Short and Long Term Outcomes

Visit Our Partner Sites

American Transplant Congress (ATC)

Visit the official site for the American Transplant Congress »

American Journal of Transplantation

The official publication for the American Society of Transplantation (AST) and the American Society of Transplant Surgeons (ASTS) »

American Society of Transplantation (AST)

An organization of more than 3000 professionals dedicated to advancing the field of transplantation. »

American Society of Transplant Surgeons (ASTS)

The society represents approximately 1,800 professionals dedicated to excellence in transplantation surgery. »

Copyright © 2013-2021 by American Society of Transplantation and the American Society of Transplant Surgeons. All rights reserved.

Privacy Policy

loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.