New Project LEOPARD
Liver transplantation (LT) is a life-saving procedure for decompensated cirrhosis (DC) and hepato-cellular carcinoma (HCC).Its efficacy is hampered by the risk of death/drop-out on the Wait List (WL). This risk is driven by organ shortage and is mitigated by organ offering schemes. According to a sickest first policy, offering schemes prioritise LT candidates with the highest risk of dying, as assessed by predictive models. To drive allocation, Organ Sharing Organizations (OSOs) use a 20-year-old model, the MELD, predicting mortality in DC but not in HCC. Because of a dramatic increase in the percentage of HCC candidates (40% against 10% in the early 20ties), MELD schemes are increasingly inaccurate, with persisting 15 to 30% mortality in countries with low/medium donation rates. This scenario, together with advances in prognosis in DC and HCC candidates and statistics, prompts the LT community to look for updated algorithms to refine offering schemes. To address this issue, key European LT stakeholders, including ELPA, OSOs, experts in LT, Statisticians, Research Labs and SMEs, joined LEOPARD (Liver Electronic Offering Platform with Artificial intelligence-based Devices). Building on an innovative, harmonised OSOs pre-LT dataset and advances in modelling, LEOPARD proposes to design and validate 1) an AI-based LEOPARD predictive algorithm outperforming current allocation models by better-stratifying patients on the risk of mortality, to be proposed OSOs to drive allocation; 2) DC & HCC LEOPARD calculators available for professional for assistance in complex decision-making processes; 3) OMICs/radiomics predictive signatures integrated in a prototype 3rd-generation exploratory model. We expect to generate computational tools to improve candidates’ outcomes, with more patients transplanted on time. Adoption of these tools should result in the harmonisation of the European heterogeneous prioritisation schemes and in a significant reduction in disparities of access to LT. LEOPARD should place Europe in a leading position for organ offering schemes. The kick-off meeting took place in Paris on January 25-26, 2024.