Use of MELD Exception Points in Patients With Hepatic Neuroendocrine Tumor Metastases: Variable Use and Proposed Criterion for Approval
1Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
2Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
3Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
4Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
Meeting: 2015 American Transplant Congress
Abstract number: C119
Keywords: Liver transplantation, Outcome, Resource utilization, Waiting lists
Session Information
Session Name: Poster Session C: Liver Donation and Allocation
Session Type: Poster Session
Date: Monday, May 4, 2015
Session Time: 5:30pm-6:30pm
Presentation Time: 5:30pm-6:30pm
Location: Exhibit Hall E
Purpose: Most patients with metastatic neuroendocrine tumors (NETs) have preserved hepatic synthetic function, and their providers may seek increased waitlist priority via MELD exception points. The roles of transplantation and MELD exceptions in these patients are controversial and gained national interest during the transplantation of Steve Jobs. In this study, we evaluate the association between receipt of MELD exception points and waiting list and post-transplantation outcomes in adult patients waitlisted for liver transplantation for metastatic neuroendocrine tumors (NETs).
Methods: We analyzed all adult patients waitlisted for liver transplantation for metastatic NETs between February 27, 2002 and June 4, 2014 through the United Network for Organ Sharing (UNOS). Waitlist outcomes (transplantation or waitlist removal for death or clinical deterioration) and post-transplantation survival were assessed based on primary exposure of receipt of MELD exception points. A multivariable model was used.
Results: Across the 11 UNOS regions, there were 230 adult patients waitlisted for metastatic NET, of which 120 (49%) received MELD exception points. Patients with an approved MELD exception were nearly twice as likely to be transplanted as those without exceptions (70.8% vs. 39.1%, p<0.001) and half as likely to be removed for death or clinical deterioration (9.2% vs. 18.2%, p=0.046). In multivariable models, post-transplantation survival was not associated with receipt of exception points, whereas increased serum total bilirubin level at transplantation was associated with significantly increased risk of post-transplant mortality. The three-year post-transplant patient survival was 78% in transplant recipients with metastatic NETs whose total bilirubin level at transplantation was <1.3 mg/dL, compared to 36.4% in those with a total bilirubin ≥1.3mg/dL.
Conclusions: Serum total bilirubin may serve as a predictor of poor post-transplant survival in patients with metastatic NETs, and could help risk-stratify patients applying for MELD exception points.
To cite this abstract in AMA style:
Nobel Y, Goldberg D. Use of MELD Exception Points in Patients With Hepatic Neuroendocrine Tumor Metastases: Variable Use and Proposed Criterion for Approval [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/use-of-meld-exception-points-in-patients-with-hepatic-neuroendocrine-tumor-metastases-variable-use-and-proposed-criterion-for-approval/. Accessed May 12, 2025.« Back to 2015 American Transplant Congress