Hepatocellular carcinoma screening in patients waiting for liver transplantation: A decision analytic model

Saab, Sammy; Ly, David; Nieto, José; Kanwal, Fasiha; Lu, David; Raman, Steven S.; Amado, Rafael G.; Nuesse, Barbara; Durazo, Francisco; Han, Steven; Farmer, Douglas G.; Ghobrial, Rafik M.; Yersiz, Hasan; Chen, Pauline; Schwegel, Kathy; Goldstein, Leonard I.; Tong, Myron J.; Busuttil, Ronald W.

doi:10.1053/jlts.2003.50120

Cited by 70 publications

(44 citation statements)

References 65 publications

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“…One cost-efficacy analysis has suggested that the increase in longevity over the whole cohort of patients awaiting transplant is negligible, because although there may be an increase in longevity in those who develop HCC, it is countered by the loss of longevity in other patients on the waiting list whose transplants are delayed so that the patient with HCC can have priority. 116 In contrast, identification of HCC that exceeds guidelines, and resultant de-listing of such patients, is beneficial to other patients on the waiting list. Another analysis suggested that there were benefits to treating patients with HCC on the transplant waiting list with either resection or local ablation.…”

Section: Surveillance Of Patients On the Liver Transplant Waiting Listmentioning

confidence: 99%

Management of hepatocellular carcinoma

2005

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Section: Surveillance Of Patients On the Liver Transplant Waiting Listmentioning

confidence: 99%

Management of hepatocellular carcinoma

2005

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“…15 In contrast to the clear benefit of accurately estimating mortality on the waiting list, MELD has not been found to be as useful in predicting mortality following liver transplantation. [16][17][18][19] Mortality in the post transplantation period is related not only to the degree of liver dysfunction prior to transplantation, but to other factors, such as donor characteristics, experience of the transplantation team, and random postoperative complications which cannot be predicted. Moreover, patient selection by physicians will tend to negate the effect of pre-transplant MELD on post transplant survival.…”

Section: Meld In Liver Transplantationmentioning

confidence: 99%

The model for end-stage liver disease (MELD)

2007

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The Model for End-stage Liver Disease (MELD) was initially created to predict survival in patients with complications of portal hypertension undergoing elective placement of transjugular intrahepatic portosystemic shunts. The MELD which uses only objective variables was validated subsequently as an accurate predictor of survival among different populations of patients with advanced liver disease. The major use of the MELD score has been in allocation of organs for liver transplantation. However, the MELD score has also been shown to predict survival in patients with cirrhosis who have infections, variceal bleeding, as well as in patients with fulminant hepatic failure and alcoholic hepatitis. MELD may be used in selection of patients for surgery other than liver transplantation and in determining optimal treatment for patients with hepatocellular carcinoma who are not candidates for liver trans- becoming the standard by which priorities in donor liver allocation were determined. Since the score was first derived in a relatively small number of patients undergoing the transjugular intrahepatic portosystemic shunts (TIPS) procedure, it has been validated in many different populations of patients with liver disease. Within a relatively short period of time, MELD became a common metric by which the severity of liver disease could be accurately described.In this paper, we review the initial development and validation of the MELD score, its application in organ allocation and management of patients with a variety of liver conditions, its strengths and limitation, and current and future efforts to refine and improve it further. Creation and Validation of MELDMELD was initially created to predict survival following elective placement of TIPS. 1 The model was subsequently validated as a predictor of survival in several cohorts of patients with varying levels of liver disease severity (e.g., hospitalized and ambulatory patients), as well as patients of geographically and temporally diverse origin. 2 The survival model was initially termed the "Mayo End-Stage Liver Disease" or "MELD" model to acknowledge the affiliation of the investigators who created the model. During discussions leading to the establishment of MELD as the basis for prioritization of organs for liver transplantation, 3,4 we changed the name to "Model for End-Stage Liver Disease" which maintained the acronym "MELD", but removed the association with a particular institution, a process that was thought would lead to wider acceptance of the model. MELD incorporates 3 widely available laboratory variables including the international normalized ratio (INR), serum creatinine, and serum bilirubin. The original mathematical formula for MELD is: MELD ϭ 9.57 ϫ log e (creatinine) ϩ 3.78 ϫ Log e (total bilirubin) ϩ 11.2 ϫ Log e (INR) ϩ 6.43.The score can be calculated on handheld computing devices, and is available at www.mayoclinic.org/gi-rst/ mayomodel5.html. When the model was initially created the etiology of cirrhosis was also included. In the TIPS

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“…However, CT and MRI are not appropriate surveillance tests because they are too expensive, invasive (radiation with CT or intravenous injection), and have limited availability in community setting [194]. Additional use of dynamic CT or dynamic MRI is recommended in patients undergoing HCC screening while awaiting liver transplantation because it may be associated with the greatest gain in life expectancy [195][196][197].…”

Section: Ct Mri and Other Imaging Modalitiesmentioning

confidence: 99%

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

et al. 2010

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Introduction The Asian Pacific Association for the Study of the Liver (APASL) convened an international working party on the management of hepatocellular carcinoma (HCC) in December 2008 to develop consensus recommendations. Methods The working party consisted of expert hepatologist, hepatobiliary surgeon, radiologist, and oncologist from Asian-Pacific region, who were requested to make drafts prior to the consensus meeting held at Bali, Indonesia on 4 December 2008. The quality of existing evidence and strength of recommendations were ranked from 1 (highest) to 5 (lowest) and from A (strongest) to D (weakest), respectively, according to the Oxford system of evidence-based approach for developing the consensus statements. 123Hepatol Int (2010) 4: 439-474 DOI 10.1007/s12072-010-9165-7 Results Participants of the consensus meeting assessed the quality of cited studies and assigned grades to the recommendation statements. Finalized recommendations were presented at the fourth APASL single topic conference on viral-related HCC at Bali, Indonesia and approved by the participants of the conference.

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Hepatocellular carcinoma screening in patients waiting for liver transplantation: A decision analytic model

Cited by 70 publications

References 65 publications

Management of hepatocellular carcinoma

Management of hepatocellular carcinoma

The model for end-stage liver disease (MELD)

Asian Pacific Association for the Study of the Liver consensus recommendations on hepatocellular carcinoma

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