MELD Exceptions and Rates of Waiting List Outcomes

Allan B. Massie; Brian Caffo; Sommer Gentry; Erin Carlyle Hall; David Axelrod; Krista L. Lentine; Mark A. Schnitzler; Adrian Gheorghian; Paolo R. Salvalaggio; Dorry L. Segev

doi:10.1111/j.1600-6143.2011.03735.x

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MELD Exceptions and Rates of Waiting List Outcomes

Journal article

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MELD Exceptions and Rates of Waiting List Outcomes

Allan B. Massie, Brian Caffo, Sommer Gentry, Erin Carlyle Hall, David Axelrod, Krista L. Lentine, Mark A. Schnitzler, Adrian Gheorghian, Paolo R. Salvalaggio and Dorry L. Segev

American journal of transplantation, Vol.11(11), pp.2362-2371

09/15/2011

DOI: 10.1111/j.1600-6143.2011.03735.x

PMCID: PMC3229963

PMID: 21920019

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Abstract

MELD-based allocation of deceased donor livers allows exceptions for patients whose score may not reflect their true mortality risk. We hypothesized that 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 UNOS from2002–2010.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% (OPO-level) and 3.7%–9.5%% (region-level).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 non-exception patients with equivalent listing priority (multinomial logistic regression 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 patients with MELD exceptions;differing rates of exceptions by OPO may create, or reflect, geographic inequity.

liver transplantation

MELD score

organ allocation

Details

Title: Subtitle: MELD Exceptions and Rates of Waiting List Outcomes
Creators: Allan B. Massie - Johns Hopkins University
Brian Caffo - Johns Hopkins University
Sommer Gentry - United States Naval Academy
Erin Carlyle Hall - Johns Hopkins Medicine
David Axelrod - Dartmouth–Hitchcock Medical Center
Krista L. Lentine - Johns Hopkins University School of Medicine
Mark A. Schnitzler - Saint Louis University
Adrian Gheorghian - Saint Louis University
Paolo R. Salvalaggio - Hospital Israelita Albert Einstein
Dorry L. Segev - Saint Louis University
Resource Type: Journal article
Publication Details: American journal of transplantation, Vol.11(11), pp.2362-2371
DOI: 10.1111/j.1600-6143.2011.03735.x
PMID: 21920019
PMCID: PMC3229963
NLM abbreviation: Am J Transplant
ISSN: 1600-6135
eISSN: 1600-6143
Language: English
Date published: 09/15/2011
Academic Unit: Surgery
Record Identifier: 9984322956002771

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