Table 2:
Criteria for standard exception points for liver transplant allocation in Canada for complications associated with cirrhosis
| Indication | British Columbia | Alberta | Ontario | Quebec | Nova Scotia |
|---|---|---|---|---|---|
| Hepatopulmonary syndrome | • PaO2 <60 mmHg or on home oxygen • No other lung disease • MMaT+3 |
• PaO2 59–56 mmHg: 22 points • PaO2 55–51 mmHg: 24 points • PaO2 <50 mmHg: 26 points • If PaO2 <50 mmHg, increase by 2 points every 3 months |
• PaO2 <60 • Baseline 22 points, increase by 3 points every 90 days; maximum 40 points |
• Significant portal hypertension • Confirmed intrapulmonary shunt • PaO2 <60 mmHg for at least 30 days prior to exception Baseline 24 points, increase by 1 point every month; maximum 28 points |
• Portal hypertension • PaO2 <60 mmHg • Confirmed intrapulmonary shunt and exclusion of intracardiac shunts • No alternative pulmonary disease to explain hypoxemia • MMaT-3 |
| Portopulmonary hypertension | • Post treatment MPAP <35 mmHg • PVR <400dynes.s.cm−5 • MMaT+3 |
• Case-by-case review • Baseline 22 points; increase by case-by-case review |
• Baseline 22 points, increase by 3 points every 90 days; maximum 40 points | • MPAP >35 mmHg • PVR >240dynes.s.cm−5 • Initial transpulmonary gradient >12 mmHg • MPAP post treatment <35 mmHg • MMaT-3 |
|
| Recurrent cholangitis | • ≥2 episodes of bacteremia in last 6 months with ≥1 episode of sepsis requiring vasoactive agents • Presence of abscess • MMaT |
• Case-by-case review (ICU admission, no. of hospitalizations, on antibiotics for prophylaxis, complications such as endocarditis or osteomyelitis) • Baseline 22 points; increase by case-by-case review |
• Two culture-proven bacteraemia episodes within a 6-month period or who have septic complications of bacterial cholangitis • Infections not related to procedure, should not have biliary tube/stent • Baseline 22 points, increase by 3 points every 90 days; maximum 40 points |
• Persistent cholestasis • Multiple non-anastomotic biliary strictures • Failed treatment of strictures • ≥2 episodes of complications including cholangitis, hepatic abscess requiring hospitalization within last 6 months • Baseline 24 points, increase by 1 point every month; maximum 28 points |
|
| Recurrent hepatic encephalopathy | • ≥2 hospitalizations for unprovoked HE on maximal therapy within last 6 months • MMaT |
• Case-by-case review (number of hospitalizations considered) • Baseline 22 points; increase by case-by-case review |
• Four hospitalizations for HE in a year lasting for at least a week • No triggers • On maximal therapy • Impacting ability to function at home/work • Baseline 18 points increase by 1 point per month; maximum 26 points |
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| Refractory ascites/hepatic hydrothorax | • Case-by-case review (number of hospitalizations considered) • Baseline 22 points; increase by case-by-case review |
• 4 thoracentesis of 1 L in the previous 12 weeks OR 1 episode of infection • Albumin gradient of ≥11 • No heart failure within 3 months • Negative cytology • TIPS contraindicated/ineffective • Diuretic intolerant/ineffective • Baseline 18 points increase by 1 point per month; maximum 26 points |
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| Refractory pruritus | • Failure of all medical therapies • Receiving plasmapheresis • Elevated serum bile acid levels • Impaired quality of life • Baseline 22 points, increase by 3 points every 90 days |
MMaT = Median Model for End-Stage Liver Disease at Transplant; PaO2 = Partial pressure of oxygen; TIPS = Transjugular intrahepatic portosystemic shunt; MPAP = Mean pulmonary artery pressure; HE = Hepatic encephalopathy; PVR = Pulmonary vascular resistance