Access to liver transplantation: Can we do a better job?

Cacciarelli, Thomas V.

doi:10.1002/lt.20493

Cited by 7 publications

(3 citation statements)

References 5 publications

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“…However, most patients for whom transplantation was not considered had potential contraindications that were inferred such as active alcohol use. Contraindications for transplantation may be more important reasons why patients appear to be sent late, although the process for LT listing in the VA may be partially responsible for the perceived delay in patient listing 19. There are currently 4 VA centers in the country offering LT but a potential patient needs to be initially evaluated in their local VA medical center with blood tests, imaging, cardiopulmonary testing, and psychosocial assessment.…”

Section: Discussionmentioning

confidence: 99%

Impact of the MELD score on waiting time and disease severity in liver transplantation in United States veterans

et al. 2007

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Organ allocation for liver transplantation (LT) in the United States is based on the Model for End-Stage Liver Disease (MELD) score. The MELD score prioritizes organ distribution to sicker patients. There is limited data on the effect of this policy on transplantation in the Veterans Affairs (VA) healthcare system. The aim of this study was to determine the impact of the MELD score on U.S. veteran patients undergoing LT. Comparison of MELD scores and waiting time of LT recipients before and after the introduction of the MELD system was done. A total of 192 LT recipients were analyzed. Blood type, diagnosis, listing MELD score, and Child-Turcotte-Pugh (CTP) score at transplant did not differ although MELD era recipients were older (mean 54.3 vs. 51.3 yr, P ϭ 0.009). Mean waiting time decreased from 461 days (pre-MELD) to 252 days (MELD era) (P ϭ 0.004). Mean MELD score at LT increased from 23.4 (MELD era) compared to 20.3 (pre-MELD) (P ϭ 0.01). In conclusion, waiting time for LT in U.S. veterans has decreased significantly in the MELD era. The MELD score of patients transplanted in the MELD era is significantly higher and patients are still being listed at a high MELD score. The MELD system has lead to sicker veterans being transplanted with shorter waiting times. Liver Transpl 13:1564Transpl 13: -1569Transpl 13: , 2007

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Section: Discussionmentioning

confidence: 99%

Impact of the MELD score on waiting time and disease severity in liver transplantation in United States veterans

et al. 2007

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“…Multiple studies (5)(6)(7)(8)(9)(10) have found that ALD patients selected for LT have similar, if not better, overall survival compared with their nonalcoholic counterparts. Commentary from the United States (11) suggested that LT may be an underused option for individuals with ALD. The main concern is the risk for recidivism.…”

Section: Les Prédicteurs De Reprise D'une Importante Consommation D'amentioning

confidence: 99%

Predictors of Relapse to Significant Alcohol Drinking after Liver Transplantation

Karim

Intaraprasong

Scudamore

et al. 2009

Canadian Journal of Gastroenterology and Hepatology

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“…Referral disparities have been implied along geographic and racial lines and for U.S. veterans. 1,[3][4][5] Alternatively, distant patients may be less likely to successfully move through the transplantation process even after referral. While level of education and income have been examined in referred patients, 6 no studies have analyzed travel time.…”

Section: See Editorial On Pagementioning

confidence: 99%

Greater travel time to a liver transplant center does not adversely affect clinical outcomes

2007

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The effect of patient travel time to a transplant center on outcomes is unknown. We compared outcomes between patients living Ͼ3 hours (Group A) vs. Յ3 (Group B) hours drive away. Adult, nonacute liver failure patients entering transplant evaluation from February 27, 2002 to January 31, 2005 were analyzed. Of 166 patients, 126 (75.5%) were listed and 66 (39.5%) received transplantation. Outcomes of interest were Ͼ90 days to list, listing, survival while listed, transplantation, and posttransplantation survival. Covariates included Model for End-Stage Liver Disease (MELD) score, hepatocellular carcinoma (HCC), alcoholic liver disease, insurance type, and psychosocial score. There were 38 (23%) patients in Group A and 128 (77%) in Group B. Median MELD scores were 14.5 (range, 6-36) for Group A and 14.0 (range, 7-32) for Group B (p ϭ 0.20). Groups were similar for age, gender, diagnosis, psychosocial score, insurance, and HCC variables.

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Access to liver transplantation: Can we do a better job?

Cited by 7 publications

References 5 publications

Impact of the MELD score on waiting time and disease severity in liver transplantation in United States veterans

Impact of the MELD score on waiting time and disease severity in liver transplantation in United States veterans

Predictors of Relapse to Significant Alcohol Drinking after Liver Transplantation

Greater travel time to a liver transplant center does not adversely affect clinical outcomes

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