+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Excess mortality on the liver transplant waiting list: unintended policy consequences and Model for End-Stage Liver Disease (MELD) inflation

Excess mortality on the liver transplant waiting list: unintended policy consequences and Model for End-Stage Liver Disease (MELD) inflation

Hepatology 61(1): 285-291

The Model for End-Stage Liver Disease (MELD) allocation system for liver transplantation provides "exceptions" for diseases such as hepatocellular carcinoma (HCC). It was the aim of this study to assess equipoise between exception candidates and nonexception candidates on the waiting list and to assess if the exception system contributes to steadily increasing regional MELD at transplant. In all, 78,595 adult liver transplant candidates between January 2005 and December 2012 were analyzed. Yearly trends in waiting list characteristics and transplantation rates were analyzed for statistical association with MELD exceptions. Regional variations in these associations and the effect of exceptions on regional MELD scores at transplant were also analyzed. 27.29% of the waiting list was occupied by candidates with exceptions. Candidates with exceptions fared much better on the waiting list compared to those without exceptions in mean days waiting (HCC 237 versus non-HCC 426), transplantation rates (HCC 79.05% versus non-HCC 40.60%), and waiting list death rates (HCC 4.49% versus non-HCC 24.63%). Strong regional variation in exception use occurred but exceptions were highly correlated with waiting list death rates, transplantation rates, and MELD score at removal in all regions. In a multivariate model predicting MELD score at transplant within regions, the percentage of HCC MELD exceptions was the strongest independent predictor of regional MELD score at transplant. Liver transplant candidates with MELD exceptions have superior outcomes compared to nonexception candidates and the current MELD exception system is largely responsible for steadily increasing MELD scores at transplant independent of geography.

Please choose payment method:

(PDF emailed within 0-6 h: $19.90)

Accession: 053112751

Download citation: RISBibTeXText

PMID: 24995689

DOI: 10.1002/hep.27283

Related references

Is the model of end-stage liver disease (MELD) valid in Israel? A critical analysis of liver transplant waiting list mortality. Israel Medical Association Journal 8(9): 605-609, 2006

Mayo end stage liver disease model score predicts liver transplant waiting list mortality Implications for liver allocation policy. Gastroenterology 120(5 Suppl. 1): A 370, 2001

Model for End stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP) scores: Ability to predict mortality and removal from liver transplantation waiting list due to poor medical conditions. Archives of Iranian Medicine 17(2): 118-121, 2014

Model for end-stage liver disease: did the new liver allocation policy affect waiting list mortality?. Archives of Surgery 142(11): 1079-1085, 2007

Validation of the five-variable Model for End-stage Liver Disease (5vMELD) for prediction of mortality on the liver transplant waiting list. Liver International 34(8): 1176-1183, 2014

Analysis of Model for End-Stage Liver Disease (MELD) score in a liver transplantation waiting list. Transplantation Proceedings 39(8): 2511-2513, 2007

Comparison of the Meld Score to Other Recently Proposed Scores With Respect To the Number of Lives Saved Among Patients With End-Stage Liver Disease on the Liver Transplant Waiting List. Gastroenterology 138(5): S-784, 2010

Higher Values in Liver Elastography and Meld Score Are Mortality Predictors on Liver Transplant Waiting List. Arquivos Brasileiros de Cirurgia Digestiva 31(1): E1360, 2018

Liver transplant waiting time does not correlate with waiting list mortality: implications for liver allocation policy. Liver Transplantation 6(5): 543-552, 2000

Model of end stage liver disease (MELD) score greater than 23 predicts length of stay in the ICU but not mortality in liver transplant recipients. Critical Care 14(3): R117, 2010

Survival before and after model for end-stage liver disease score introduction on the Brazilian liver transplant waiting list. Transplantation Proceedings 42(2): 412-416, 2010

A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: A competing risk analysis in a national cohort. Journal of Hepatology 68(4): 707-714, 2018

Improved waiting-list outcomes in Argentina after the adoption of a model for end-stage liver disease-based liver allocation policy. Liver Transplantation 19(7): 711-720, 2013

Impact of MELD Allocation System on Waiting List and Early Post-Liver Transplant Mortality. Plos one 11(6): E0155822, 2016

Change in model for end-stage liver disease score on the transplant waiting list predicts survival in patients undergoing liver transplantation. Transplant International 19(12): 988-994, 2006