Congly Stephen E, Marquez Vladimir, Bhanji Rahima A, Bhat Mamatha, Wong Philip, Huard Geneviève, Zhu Julie H, Brahmania Mayur
Divisions of Gastroenterology and Hepatology and Transplant Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada.
Can Liver J. 2023 Jul 26;6(2):201-214. doi: 10.3138/canlivj-2022-0026. eCollection 2023 Jul.
Exception points for liver transplant (LT) allocation are used to account for mortality risk not reflected by scoring systems such as the Model for End-Stage Liver Disease with sodium (MELD-Na). Currently, there is no formal policy regarding exception points in Canada, and differences across the country are not well understood. As such, a review of the criteria and exception points granted throughout the country for LT was conducted.
Seven LT centres in five provinces were surveyed (Vancouver, Edmonton, London, Toronto, Montréal, Halifax) regarding the indications and criteria for exception points granted, the number of points granted, how points would be accrued, and the maximum points granted.
Programs in British Columbia and Nova Scotia grant variable exception points based on the median MELD-Na score with modifications; Alberta, Ontario, and Quebec grant exception points using specific values based on the indication. Overall, there was significant heterogeneity regarding exception points granted nationally with agreement only for awarding exception points for hepatopulmonary syndrome and polycystic liver disease. The second most common agreed-upon indications for exception points were portopulmonary hypertension and recurrent cholangitis offered by four provinces. Quebec had the most formal criteria for non-cirrhosis-based conditions.
There is substantial variance across the country regarding the indications for granting exception points as well as the number of points granted. Future work on developing a national consensus will be important for the development of equity in LT across Canada.
肝移植（LT）分配的例外点用于考虑诸如含钠终末期肝病模型（MELD-Na）等评分系统未反映的死亡风险。目前，加拿大没有关于例外点的正式政策，全国各地的差异也未得到充分了解。因此，对全国范围内LT的例外点标准和授予情况进行了审查。
对五个省份的七个LT中心（温哥华、埃德蒙顿、伦敦、多伦多、蒙特利尔、哈利法克斯）进行了调查，内容包括授予例外点的适应症和标准、授予的点数、点数的累积方式以及授予的最大点数。
不列颠哥伦比亚省和新斯科舍省根据MELD-Na中位数评分并进行调整来授予可变的例外点；艾伯塔省、安大略省和魁北克省根据适应症使用特定值来授予例外点。总体而言，全国范围内授予的例外点存在显著异质性，仅在授予肝肺综合征和多囊肝病的例外点方面达成一致。第二常见的一致认可的例外点适应症是四个省份提供的门肺高压和复发性胆管炎。魁北克省对非肝硬化相关情况有最正式的标准。
在授予例外点的适应症以及授予的点数方面，全国各地存在很大差异。未来就制定全国共识开展工作对于在加拿大实现肝移植公平性至关重要。
