Page 87 - Read Online

Hakeem et al. Hepatoma Res 2023;9:38 https://dx.doi.org/10.20517/2394-5079.2023.59 Page 7 of 14

Figure 1. Flowchart depicting the patient pathway for the liver transplantation for ≤ 2 cm iCCA. iCCA: Intrahepatic cholangiocarcinoma.

ORGAN ALLOCATION AND PRIORITISATION
For elective adult LT in the UK, the patient selection criteria require a predicted 5-year survival rate of over
50% after transplantation, with an acceptable quality of life. Based on the published literature and a more
conservative oncological approach, a similar survival rate cut-off would be reasonable for iCCA patients in
this new service evaluation. An organ allocation system’s main goal should be to distribute donor organs
fairly to patients who are on the waitlist, in line with ethical principles such as equity, utility, benefit,
urgency, and fairness. The NHSBT implemented the National Liver Offering Scheme (NLOS) in 2018. This
revised method for matching livers from deceased donors to adult patients on the liver transplant matching
list operates at a national level, as opposed to a regional one. The NLOS aims to allocate the liver to chronic
liver disease and HCC patients who could benefit most from the transplant. The new scheme is
comprehensive and considers 21 recipient factors and 7 donor factors. The patient with the best match will
be shown at the top of the list and will have the highest Transplant Benefit Score (TBS), thereby giving them
the maximum “net benefit” (difference in predicted survival with and without transplant). The FTWG plan
is to provide a graft within the “variant group” of the UK NLOS to the patients who are listed for LT for
iCCA. The variant list is specifically for patients with UKELD score < 49, such as those with diuretic-
resistant ascites, hepatopulmonary syndrome, chronic hepatic encephalopathy, and other indications of
quality of life. The algorithm will consider the three-month oncological window for iCCA patients, and they
will be given priority on the variant list, both at the local center and at national levels. In view of this short
window from assessment to transplant, the FTWG did not feel there was a need to bridge the tumour with