Higher Mortality in registrants with sudden model for end-stage liver disease increase: Disadvantaged by the current allocation policy

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
A B MassieDorry L Segev

Abstract

Liver allocation is based on current Model for End-Stage Liver Disease (MELD) scores, with priority in the case of a tie being given to those waiting the longest with a given MELD score. We hypothesized that this priority might not reflect risk: registrants whose MELD score has recently increased receive lower priority but might have higher wait-list mortality. We studied wait-list and posttransplant mortality in 69,643 adult registrants from 2002 to 2013. By likelihood maximization, we empirically defined a MELD spike as a MELD increase ≥ 30% over the previous 7 days. At any given time, only 0.6% of wait-list patients experienced a spike; however, these patients accounted for 25% of all wait-list deaths. Registrants who reached a given MELD score after a spike had higher wait-list mortality in the ensuing 7 days than those with the same resulting MELD score who did not spike, but they had no difference in posttransplant mortality. The spike-associated wait-list mortality increase was highest for registrants with medium MELD scores: specifically, 2.3-fold higher (spike versus no spike) for a MELD score of 10, 4.0-fold higher for a MELD score of 20, and 2.5-fold higher for a MELD score of 30. A model incorporating the MELD score...Continue Reading

References

Feb 15, 2001·Hepatology : Official Journal of the American Association for the Study of Liver Diseases·P S KamathW R Kim
Jan 4, 2003·Gastroenterology·Russell WiesnerUNKNOWN United Network for Organ Sharing Liver Disease Severity Score Committee
Jan 7, 2003·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Robert M MerionPhilip J Held
Oct 13, 2004·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Richard B Freeman
Oct 13, 2004·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Kiran BambhaE Rolland Dickson
May 30, 2009·BMJ : British Medical Journal·Douglas G AltmanKarel G M Moons
Sep 17, 2011·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·A B MassieD L Segev
Oct 29, 2011·Clinics in Liver Disease·Sumeet K Asrani, W Ray Kim

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Citations

Mar 19, 2016·Transplant International : Official Journal of the European Society for Organ Transplantation·Alexander J C IJtsmaMaarten J H Slooff
Jul 28, 2018·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Xun LuoDorry L Segev
Aug 2, 2019·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Sonja M SwensonEmily R Perito
Mar 15, 2016·World Journal of Gastroenterology : WJG·Michael L Schilsky, Maryam Moini
Dec 15, 2017·United European Gastroenterology Journal·Lukas W UngerGabriela A Berlakovich
Apr 20, 2021·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Tanveen IshaqueAllan B Massie
Jun 27, 2021·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Ben F J GoudsmitHein Putter

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