The National Liver Offering Scheme (NLOS) was introduced in the UK in 2018 to offer livers from deceased donors to patients on the national waiting list based, for most patients, on calculated transplant benefit. Before NLOS, livers were offered to transplant centres by geographic donor zones and, within centres, by estimated recipient need for a transplant. UK Transplant Registry data on patient registrations and transplants were analysed to build statistical models for survival on the list (M1) and survival post-transplantation (M2). A separate cohort of registrations – not seen by the models before – was analysed to simulate what liver allocation would have been under M1, M2 and a transplant benefit score (TBS) model (combining both M1 and M2), and to compare these allocations to what had been recorded in the UK Transplant Registry. The number of deaths on the waiting list and patient life years were used to compare the different simulation scenarios and to select the optimal allocation model. Registry data were monitored, pre- and post-NLOS, to understand the performance of the scheme. The TBS was identified as the optimal model to offer donation after brain death (DBD) livers to adult and large paediatric elective recipients. In the first 2 years of NLOS, 68% of DBD livers were offered using the TBS to this type of recipient. Monitoring data indicate that mortality on the waiting list post-NLOS significantly decreased compared with pre-NLOS ( <0.0001), and that patient survival post-listing was significantly greater post-compared to pre-NLOS ( = 0.005). In the first two years of NLOS offering, waiting list mortality fell while post-transplant survival was not negatively impacted, delivering on the scheme’s objectives. The National Liver Offering Scheme (NLOS) was introduced in the UK in 2018 to increase transparency of the deceased donor liver offering process, maximise the overall survival of the waiting list population, and improve equity of access to liver transplantation. To our knowledge, it is the first scheme that offers organs based on statistical prediction of transplant benefit: the transplant benefit score. The results are important to the transplant community – from healthcare practitioners to patients – and demonstrate that, in the first two years of NLOS offering, waiting list mortality fell while post-transplant survival was not negatively impacted, thus delivering on the scheme’s objectives. The scheme continues to be monitored to ensure that the transplant benefit score remains up-to-date and that signals that suggest the possible disadvantage of some patients are investigated.

中文翻译：

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英国基于福利的死者捐献肝脏移植服务


英国于 2018 年推出了国家肝脏提供计划 (NLOS)，根据计算得出的移植效益，向国家等待名单上的患者提供已故捐献者的肝脏。在 NLOS 之前，肝脏按地理供体区域提供给移植中心，在中心内则按估计的受者移植需求提供。对英国移植登记处有关患者登记和移植的数据进行了分析，以建立名单上存活率 (M1) 和移植后存活率 (M2) 的统计模型。对一组单独的注册（以前的模型未曾见过）进行了分析，以模拟 M1、M2 和移植效益评分 (TBS) 模型（结合 M1 和 M2）下的肝脏分配情况，并将这些分配与英国移植登记处记录的内容。使用等待名单上的死亡人数和患者生命年来比较不同的模拟场景并选择最佳分配模型。在 NLOS 之前和之后对注册数据进行监测，以了解该计划的绩效。 TBS 被认为是向成人和大型儿科选择性受者提供脑死亡 (DBD) 肝脏捐赠的最佳模式。在 NLOS 的前 2 年，68% 的 DBD 肝脏是通过 TBS 提供给此类接受者的。监测数据表明，与 NLOS 前相比，NLOS 后等候名单上的死亡率显着下降 (<0.0001)，并且与 NLOS 前相比，排队后的患者生存率显着更高 (= 0.005)。在 NLOS 提供的头两年，等待名单死亡率下降，而移植后存活率没有受到负面影响，实现了该计划的目标。 英国于 2018 年推出国家肝脏提供计划 (NLOS)，旨在提高已故捐献肝脏提供过程的透明度，最大限度地提高等待名单人群的总体生存率，并提高肝移植机会的公平性。据我们所知，这是第一个基于移植效益统计预测提供器官的方案：移植效益评分。结果对移植界（从医疗保健从业者到患者）都很重要，并表明，在 NLOS 提供的头两年中，等待名单死亡率下降，而移植后生存没有受到负面影响，从而实现了该计划的目标。该计划将继续受到监测，以确保移植效益评分保持最新，并对表明某些患者可能存在不利的信号进行调查。