Liver transplant allocation policies and outcomes in United States: A comprehensive review

Table 4 Conditions eligible for non-hepatocellular carcinoma standard model for end-stage liver disease-exceptions

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.