Decision support for organ offers in liver transplantation

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
M L VolkKerby Shedden

Abstract

Organ offers in liver transplantation are high-risk medical decisions with a low certainty of whether a better liver offer will come along before death. We hypothesized that decision support could improve the decision to accept or decline. With data from the Scientific Registry of Transplant Recipients, survival models were constructed for 42,857 waiting-list patients and 28,653 posttransplant patients from 2002 to 2008. Daily covariate-adjusted survival probabilities from these 2 models were combined into a 5-year area under the curve to create an individualized prediction of whether an organ offer should be accepted for a given patient. Among 650,832 organ offers from 2008 to 2013, patient survival was compared by whether the clinical decision was concordant or discordant with model predictions. The acceptance benefit (AB)--the predicted gain or loss of life by accepting a given organ versus waiting for the next organ--ranged from 3 to -22 years (harm) and varied geographically; for example, the average benefit of accepting a donation after cardiac death organ ranged from 0.47 to -0.71 years by donation service area. Among organ offers, even when AB was >1 year, the offer was only accepted 10% of the time. Patient survival fr...Continue Reading

References

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Oct 23, 2012·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Jeffrey B HalldorsonJohn Paul Roberts
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Citations

Jul 1, 2015·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Russell H Wiesner
Feb 28, 2017·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·David S GoldbergPeter L Abt
Apr 20, 2018·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Andrew WeyJon J Snyder
May 18, 2017·Transplantation·Dimitris BertsimasParsia A Vagefi
Dec 6, 2018·Current Opinion in Organ Transplantation·Beau KellyGeorge V Mazariegos
Jan 8, 2019·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Christine E HaugenDorry L Segev
Feb 13, 2019·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Michael L Volk, Peter Abt
May 19, 2019·Transplant Infectious Disease : an Official Journal of the Transplantation Society·Hannah K SmalleyMatthew J Kuehnert
Aug 25, 2020·Zeitschrift für Gastroenterologie·Simon MoosburnerJohann Pratschke
Sep 17, 2020·Transplant International : Official Journal of the European Society for Organ Transplantation·James Neuberger, Chris Callaghan
May 4, 2021·Transplantation Direct·Cory R SchaffhausenAjay K Israni
Jul 18, 2017·Gastroenterology·Evelyn K HsuJennifer C Lai

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