Katina Zheng’s bio
Dr. Katina Zheng, MD received her medical degree from the University of Ottawa and is now a second-year internal medicine resident at the University of Toronto. She has had a longstanding interest in organ donation and transplantation, which was first sparked early on in her medical school training. She continues to actively pursue research under the supervision of Dr. Bhat with a focus on liver transplantation.
Live donor liver transplantation in primary sclerosing cholangitis: an indicator of an organ allocation system not addressing patient need
Fernanda Onofrio, Katina Zheng, Cherry Xu, Shiyi Chen, Aliya Gulamhusein, Cynthia Tsien1, Keyur Patel, Nazia Selzner, Leslie Lilly, Gideon Hirschfield, Mamatha Bhat
Background: Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease where transplantation is the only definitive treatment option. Patients are waitlisted for liver transplant (LT) according to the MELD-Na score, which may not accurately reflect the burden of disease in this condition. We sought to describe and analyze the clinical course over time of patients with PSC referred for LT, in a mixed deceased donor/live donor transplant programme.
Methods: A retrospective cohort study from November 2012 to December 2019 including all patients with PSC referred for assessment at the University Health Network Liver Transplant Clinic. Liver symptoms, hepatobiliary malignancy, MELD-Na progression, and death were assessed.
Results: Of 172 PSC patients assessed for transplant, 144 (84%) were listed of which 106/144 (74%) were transplanted. The mean age was 47.6 years and 66% were male. During the follow-up period, 26/144 (18%) were removed from the waitlist due to infection, clinical deterioration, liver-related mortality, or new cancer. At time of listing, 118/144 (81.95%) had a potential Living Donor (pLD), of whom 94 were transplanted: 64 live donor LT (LDLT) and 30 deceased donor LT (DDLT). Overall mortality was 79% lower in patients with a potential living donor (p<0.001). Exception points were granted to 13/172 (7.5%) patients.
Conclusions: Overall, the majority of PSC patients assessed for transplant were listed and subsequently transplanted. Only a minority of patients received exception points, which reflects the difficulty in fulfilling criteria. Waitlist mortality was 11.8% which is lower than other indications for LT. The majority of PSC transplanted patients underwent LDLT; this may be indirect evidence of patients and clinicians recognising that the current MELD-Na allocation system does not accurately reflect their degree of illness/clinical need. Evaluation of approaches to managing deceased donor allocation for patients with PSC is needed to make this more equitable.