Table 4.
Condition
|
Requirements for exception points
|
MELD score assigned
|
CCA | Un-resectable hilar CCA with biopsy/cytology consistent with malignancy or CA19-9 > 100 U/mL or aneuploidy | MMaT-3 |
Center must have written protocol regarding selection of criteria, neoadjuvant therapy, operative staging for metastatic disease | ||
Imaging to exclude metastatic disease | ||
HPS | Evidence of portal hypertension without any evidence of underlying significant pulmonary disease | MMaT-3 |
PaO2 < 60 mmHg on room air | ||
ECHO or lung scan confirming intra-pulmonary shunt | ||
POPH | Evidence of portal hypertension along with MPAP > 35 mmHg and PVR > 3 woods unit | MMaT-3 |
MPAP < 35 mmHg and PVR < 5.1 woods unit post treatment of pulmonary hypertension | ||
FAP | Biopsy proven amyloid along with TTR gene mutation and able to walk independently | MMaT-3 |
Must be on heart transplant wait list or EF > 40% on ECHO within 30 d | ||
Cystic fibrosis | Genetic analysis confirmation needed | MMaT-3 |
FEV1 below 40% of predicted FEV1 with 30 d prior to initial request | ||
HAT | HAT within 2 wk of OLT | 40 |
Primary hyperoxaluria | AGT deficiency proven on liver biopsy/genetic analysis | MMaT |
On kidney transplant list with eGFR ≤ 25 mL/min on two instances 42 d apart |
CA19-9: Carbohydrate antigen 19-9; FEV1: Forced expiratory volume at one second; TTR: Transthyretin; AGT: Alanine glyoxylate aminotransferase; MELD: Model for end-stage liver disease; CCA: Cholangiocarcinoma; HPS: Hepatopulmonary syndrome; MPAP: Mean pulmonary artery pressure; FAP: Familial amyloid polyneuropathy; HAT: Hepatic artery thrombosis; PVR: Pulmonary vascular resistance; POPH: Portopulmonary hypertension.