Results of the first year of the new liver allocation plan

Abstract

Wolfe, and the UNOS/OPTN Liver and Intestine Transplantation CommitteeLiver allocation policy in the U.S. was recently changed to a continuous disease severity scale with minimal weight given to time waiting in an effort to better prioritize deceased donor liver transplant candidates. We compared rates of waiting list registrations, removals, transplants, and deaths during the year prior to implementation of the new liver allocation policy (2/27/01-2/26/02, Era 1) with the first year's experience (2/27/02-2/26/03, Era 2) under this new policy. Rates were adjusted for 1,000 patient years on the waiting list and compared using z-tests. A 1-sided test was used to compare death rates; 2-sided tests were used to compare transplant rates. Overall and subgroup analyses were performed for demographic, geographic, and medical strata. In Era 2, we observed a 12% reduction in new liver transplant waiting list registrations, with the largest reductions seen in new registrants with low MELD/PELD scores. In Era 2, there was a 3.5% reduction in waiting list death rate (P ‫؍‬ .076) and a 10.2% increase in cadaveric transplants (P < .001). The reduction in waiting list mortality and increase in transplantation rates were evenly distributed across all demographic and medical strata, with some variation across geographic variables. Early patient and graft survival after deceased donor liver transplantation remains unchanged. In conclusion, by eliminating the categorical waiting list prioritization system that emphasized time waiting, the new system has been associated with reduced registrations and improved transplantation rates without increased mortality rates for individual groups of waiting candidates or changes in early transplant survival rates. (Liver Transpl 2004;10:7-15.)

Models for prediction of mortality from cirrhosis with special reference to artificial neural network: a critical review

“…The revised model currently used by the United Network for Organ Sharing (UNOS) in prioritizing allocation of organs for liver transplantation is calculated according to the following formula: MELD = 3.8[Ln serum bilirubin (mg/dl)] + 11.2[Ln INR] + 9.6[Ln serum creatinine (mg/dl)] + 6.4, where Ln is the natural logarithm. Although the MELD score was originally described for selection of patients for TIPS, it has been most widely used for the allocation of liver transplants and a recent study documented the utility of MELD score in de-emphasizing waiting time as a major factor in prioritizing patients for liver transplantation and, in addition, use of MELD score is associated with increased transplantation rates without concomitant increased mortality rates [37]. Besides the above-mentioned indications, MELD score has also been evaluated for prediction of mortality associated with alcoholic hepatitis, hepatorenal syndrome, acute liver failure, sepsis in cirrhosis, and perioperative mortality in patients with chronic liver disease [27].…”

New aspects of diagnosis and therapy of hepatocellular carcinoma

“…Finally, giving excessive priority to too advanced or too sick patients may hamper the long-term results because of higher rates of recurrence, death or both. In the US, HCC patients were initially given extra points to match the risk of death in end-stage cirrhosis: 24 for solitary HCC o2 cm and 29 for solitary HCC 2-5 cm or three nodules o3 cm each (Freeman et al, 2004). However, these numbers gave HCC patients too high a priority (Sharma et al, 2004), and they were subsequently lowered several times and are currently 0 and 22, respectively (Freeman et al, 2004).…”

Liver transplantation: expectation with MELD score for liver allocation in Brazil

“…In addition, waiting list mortality rate was reduced. 20 In Brazil, a recently published decree instituted the criterion of disease severity for liver allocation, witch started to be valid 30 days after publication. 16 Analysis of the results and impact of change on the Brazilian reality is currently underway.…”