Ongoing Review of National Liver Review Board (NLRB) Diagnoses

At a glance

Current policy

When a liver transplant program believes that a candidate’s calculated model for end-stage liver disease (MELD) or pediatric end-stage liver disease (PELD) score does not accurately reflect their medical urgency for transplant, they can submit a request for a MELD or PELD exception score. The National Liver Review Board (NLRB) reviews requests from transplant programs for these exception scores. The NLRB uses policy and guidance documents to decide whether to approve or deny exception score requests. Since implementation in 2019, the OPTN Liver and Intestinal Organ Transplantation Committee has regularly evaluated the NLRB to identify opportunities for improvement.

Supporting media

Presentation

View presentation

Proposed changes

• Update Hepatocellular Carcinoma (HCC) policy to align with the terminology used by the American College of Radiology.
• Simplify guidance for candidates who had HCC that was treated and subsequently recurs.
• Update guidance for candidates meeting criteria for Ischemic Cholangiopathy (IC) so they will get a score equal to median MELD at transplant (MMaT).
• Update polycystic liver disease (PLD) guidance by clarifying list of qualifying comorbidities and recommending all candidates meeting criteria be considered for a score equal to MMaT.

Anticipated impact

• What it's expected to do
  • Provide NLRB members with updated guidance to use when reviewing MELD exception requests for specific candidates
  • Ensure the transplant community is using consistent terminology for HCC exceptions
• What it won't do
  • Will not impact how liver candidates are prioritized on a match run

Terms to know

• Guidance Documents: Documents that provide more information to transplant programs and NLRB members to use when making decisions on exception requests
• Model for End-Stage Liver Disease (MELD): The scoring system used in allocation of livers to candidates who are at least 12 years old
• Pediatric End-Stage Liver Disease (PELD): The scoring system used in allocation of livers to candidates who are under 12 years old
• National Liver Review Board (NLRB): A review board of members drawn from a nationwide pool of liver transplant physicians and surgeons, who review exception requests from transplant programs for candidates whose automatically calculated model for end-stage liver disease (MELD) score or pediatric end-stage liver disease (PELD) score does not accurately reflect the candidate’s medical urgency for transplant.
• Standardized exception: A exception with criteria outlined in policy that is automatically approved when submitted and is not reviewed by the NLRB
• Hepatocellular Carcinoma (HCC): The most common type of primary liver cancer
• Ischemic Cholangiopathy (IC): Extensive damage to the bile ducts due to impaired blood supply
• Polycystic liver disease (PLD): The growth of more than 10 cysts in the liver

Click here to search the OPTN glossary