TY - JOUR
T1 - MELD exceptions and rates of waiting list outcomes
AU - Massie, A. B.
AU - Caffo, B.
AU - Gentry, S. E.
AU - Hall, E. C.
AU - Axelrod, D. A.
AU - Lentine, K. L.
AU - Schnitzler, M. A.
AU - Gheorghian, A.
AU - Salvalaggio, P. R.
AU - Segev, D. L.
PY - 2011/11
Y1 - 2011/11
N2 - Model for End-stage Liver Disease (MELD)-based allocation of deceased donor livers allows exceptions for patients whose score may not reflect their truemortality risk. We hypothesized that organ procurement organizations (OPOs) may differ in exception practices, use of exceptions may be increasing over time, and exception patients may be advantaged relative to other patients. We analyzed longitudinal MELD score, exception and outcome in 88 981 adult liver candidates as reported to the United Network for Organ Sharing from 2002 to 2010. Proportion of patients receiving an HCC exception was 0-21.4% at the OPO-level and 11.9-18.8% at the region level; proportion receiving an exception for other conditions was 0.0% -13.1% (OPOlevel) and 3.7-9.5 (region-level). Hepatocellular carcinoma (HCC) exceptions rose over time (10.5% in 2002 vs. 15.5% in 2008, HR = 1.09 per year, p<0.001) as did other exceptions (7.0% in 2002 vs. 13.5% in 2008, HR = 1.11, p<0.001). In the most recent era of HCC point assignment (since April 2005), both HCC and other exceptions were associated with decreased risk of waitlist mortality compared to nonexception patients with equivalent listing priority (multinomial logistic regression odds ratio [OR] = 0.47 for HCC, OR = 0.43 for other, p<0.001) and increased odds of transplant (OR = 1.65 for HCC, OR = 1.33 for other, p<0.001). Policy advantages patientswithMELD exceptions; differing rates of exceptions by OPO may create, or reflect, geographic inequity.
AB - Model for End-stage Liver Disease (MELD)-based allocation of deceased donor livers allows exceptions for patients whose score may not reflect their truemortality risk. We hypothesized that organ procurement organizations (OPOs) may differ in exception practices, use of exceptions may be increasing over time, and exception patients may be advantaged relative to other patients. We analyzed longitudinal MELD score, exception and outcome in 88 981 adult liver candidates as reported to the United Network for Organ Sharing from 2002 to 2010. Proportion of patients receiving an HCC exception was 0-21.4% at the OPO-level and 11.9-18.8% at the region level; proportion receiving an exception for other conditions was 0.0% -13.1% (OPOlevel) and 3.7-9.5 (region-level). Hepatocellular carcinoma (HCC) exceptions rose over time (10.5% in 2002 vs. 15.5% in 2008, HR = 1.09 per year, p<0.001) as did other exceptions (7.0% in 2002 vs. 13.5% in 2008, HR = 1.11, p<0.001). In the most recent era of HCC point assignment (since April 2005), both HCC and other exceptions were associated with decreased risk of waitlist mortality compared to nonexception patients with equivalent listing priority (multinomial logistic regression odds ratio [OR] = 0.47 for HCC, OR = 0.43 for other, p<0.001) and increased odds of transplant (OR = 1.65 for HCC, OR = 1.33 for other, p<0.001). Policy advantages patientswithMELD exceptions; differing rates of exceptions by OPO may create, or reflect, geographic inequity.
KW - Liver transplantation
KW - MELD score
KW - Organ allocation
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U2 - 10.1111/j.1600-6143.2011.03735.x
DO - 10.1111/j.1600-6143.2011.03735.x
M3 - Article
C2 - 21920019
AN - SCOPUS:84855417506
VL - 11
SP - 2362
EP - 2371
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
IS - 11
ER -