Table 3:
Criteria for standard exception points for liver transplant allocation in Canada for conditions not related to complications associated with cirrhosis
| Indication | British Columbia | Alberta | Ontario | Quebec | Nova Scotia |
|---|---|---|---|---|---|
| Hereditary haemorrhagic telangiectasia | • No extrahepatic disease • Evidence of high output cardiac failure, biliary ischemia, or significant portal hypertension • MMaT+3 |
• Evidence of cardiac insufficiency within 3 months prior to request • Demonstration of AVM in the liver on imaging or severe bibulbar necrosis • Baseline 18 points, increase by 1 point per month; maximum 26 points |
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| Familial amyloid polyneuropathy | • Evidence of neurological impairment • MMaT |
• Baseline 22 points, increase by 2 points every 3 months | • Baseline 22 points, increase by 3 points every 90 days; maximum 40 points | • If significant heart failure, would accept a heart/liver transplant • EF >40% • Able to walk alone • Evidence of transthyretin mutation • Amyloidosis proven by biopsy • Baseline 18 points, increase by 1 point per month; maximum of 26 points |
|
| Cystic fibrosis | • If on lung transplant list as well • MMaT+3 |
• If poor lung function/deterioration • Baseline 25 points, increase by 2–3 points every 3 months |
• Baseline 22 points, increase by 3 points every 90 days; maximum 40 points | • With decompensated cirrhosis • Baseline 24 points, increase by 1 point every month; maximum 28 points |
|
| Cholangiocarcinoma | • MMaT+3 | • After laparotomy for node sampling • Baseline 30 points |
• Baseline 22 points, increase by 3 points every 90 days; maximum 40 points | • Received neoadjuvant therapy • Cholangiocarcinoma diagnosed by malignant stricture with at least one of the following: biopsy/cytology consistent with tumour, CA 19–9 >100 without cholangitis, aneulplody • Unresectable lesion; lesion <3 cm in size • No history of biopsy/aspiration transperineally, no extrahepatic metastases • Baseline 24 points, increase by 1 point every month; maximum 28 points |
|
| Metabolic disease (eg, Maple syrup urine disease, hyperoxaluria type 1, hereditary amyloid) | • Evidence of neurological impairment • MMaT |
• Baseline 22 points, increase by 3 points every 90 days; maximum 40 points | • Baseline 24 points, increase by 1 point every month; maximum 28 points | ||
| Multiple hepatic adenomas | • Unresectable hepatic adenomas with at least one of the criteria: a) Malignant transformation of one lesion <2 cm proven by biopsy, b) glycogen storage disorder, c) Beta-catenin mutation • Baseline 18 points increase by 1 point per month; maximum 26 points |
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| Hepatic epithelioid hemangioendothelioma | • Unresectable liver lesions that are biopsy proven • If any extrahepatic metastatic disease, stable for 3 months prior to exception points • Baseline 24 points, increase by 1 point every month; maximum 28 points |
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| Neuroendocrine tumour | • Primary tumour resected and stable for at least 6 months • ≤50% of liver volume • Age ≤60 • MMaT+3 |
• Age <65 • Primary lesion and extrahepatic metastatic lesions resected with no growth for 6 months • Unresectable liver lesions, <50% of liver volume • Primary from GI/liver source (drained by portal vein) • Tumour well/moderately differentiated with a mitotic index <20/10 HPF and KI-67 <20% • Baseline 24 points, increase by 1 point every month; maximum 28 points |
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| Polycystic liver disease | • Evidence of portal hypertension or complications due to mass effect (eg, malnutrition), or recurrent cyst infections • MMaT |
• Case-by-case review (malnutrition, or infection of cysts) • Baseline 22 points, increase based on case-by-case review |
• Baseline 22 points, increase by 3 points every 90 days; maximum 40 points | • Mayo Class C or D with either hepatic decompensation or significant sarcopenia • Baseline 18 points increase by 1 point per month; maximum 26 points |
• If meets one of following criteria: 1. Ascites or variceal bleeding 2. Budd-Chiari-like-syndrome with • Hepato-venous outflow obstruction due to cysts (CT/MRI, Venography) 3. Ascites complicating cyst fenestration procedures 4. Severe malnutrition (as documented by RD assessment) • MMaT-3 |
| Multi-organ transplant requiring same donor | • Case-by-case review | • Liver-lung or liver-heart: 42 points • Liver-bowel: 22 points plus 10% for the risk of 3-month mortality, increase 3 points plus 10% every 90 days; maximum 40 points • Liver-kidney/liver-pancreas: Baseline 22 points, increase by 3 points every 90 days; maximum 40 points |
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| Primary hyperoxaluria | • Evidence of neurological impairment • MMaT |
• Baseline 22 points, increase by 3 points every 90 days; maximum 40 points | • Candidate for liver/kidney transplant • Biopsy proven AGT deficiency • GFR <25 ml/min on 2 times separated by 42 days • Baseline 24 points, increase by 1 point every month; maximum 28 points |
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| Repeat liver transplantation | • 25 points, increase based on case-by-case review | ||||
| Hepatic artery thrombosis post LT (within 7 days) | Status 4F | Status 4F | Status 4F | Status 4F | Status 4F |
| Primary non function of graft | Status 4F | Status 4F | Status 4F | Status 4F | Status 4F |
MMaT = Median Model for End-Stage Liver Disease at Transplant; AVM = Arteriovenous malformation; EF = Ejection fraction; RD = Registered dietitian; GI = Gastrointestinal; HPF = High powered field; AGT = Alanine glyoxylate aminotransferase; GFR = Glomerular filtration rate; LT = Liver transplant; CA 19-9 = Carbohydrate antigen 19-9