TY - JOUR
T1 - MELD as a metric for survival benefit of liver transplantation
AU - Luo, Xun
AU - Leanza, Joseph
AU - Massie, Allan B.
AU - Garonzik-Wang, Jacqueline M.
AU - Haugen, Christine E.
AU - Gentry, Sommer E.
AU - Ottmann, Shane E.
AU - Segev, Dorry L.
N1 - Funding Information:
This work was supported by a Doris Duke Charitable Foundation Grant 2015055 (PI: Dorry Segev), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) grant number K24DK101828 (PI: Dorry Segev), and National Institute on Aging (NIA) grant number F32AG053025 (PI: Christine Haugen). The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Doris Duke Charitable Foundation or the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the Doris Duke Charitable Foundation or the US Government.
Funding Information:
This work was conducted under the support of the Minneapolis Medical Research Foundation, contractor for the Scientific Registry of Transplant Recipients, as a deliverable under contract no.
Publisher Copyright:
© 2018 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2018/5
Y1 - 2018/5
N2 - Currently, there is debate among the liver transplant community regarding the most appropriate mechanism for organ allocation: urgency-based (MELD) versus utility-based (survival benefit). We hypothesize that MELD and survival benefit are closely associated, and therefore, our current MELD-based allocation already reflects utility-based allocation. We used generalized gamma parametric models to quantify survival benefit of LT across MELD categories among 74 196 adult liver-only active candidates between 2006 and 2016 in the United States. We calculated time ratios (TR) of relative life expectancy with transplantation versus without and calculated expected life years gained after LT. LT extended life expectancy (TR > 1) for patients with MELD > 10. The highest MELD was associated with the longest relative life expectancy (TR = 1.05 1.20 1.37 for MELD 11-15, 2.29 2.49 2.70 for MELD 16-20, 5.30 5.72 6.16 for MELD 21-25, 15.12 16.35 17.67 for MELD 26-30; 39.26 43.21 47.55 for MELD 31-34; 120.04 128.25 137.02 for MELD 35-40). As a result, candidates with the highest MELD gained the most life years after LT: 0.2, 1.5, 3.5, 5.8, 6.9, 7.2 years for MELD 11-15, 16-20, 21-25, 26-30, 31-34, 35-40, respectively. Therefore, prioritizing candidates by MELD remains a simple, effective strategy for prioritizing candidates with a higher transplant survival benefit over those with lower survival benefit.
AB - Currently, there is debate among the liver transplant community regarding the most appropriate mechanism for organ allocation: urgency-based (MELD) versus utility-based (survival benefit). We hypothesize that MELD and survival benefit are closely associated, and therefore, our current MELD-based allocation already reflects utility-based allocation. We used generalized gamma parametric models to quantify survival benefit of LT across MELD categories among 74 196 adult liver-only active candidates between 2006 and 2016 in the United States. We calculated time ratios (TR) of relative life expectancy with transplantation versus without and calculated expected life years gained after LT. LT extended life expectancy (TR > 1) for patients with MELD > 10. The highest MELD was associated with the longest relative life expectancy (TR = 1.05 1.20 1.37 for MELD 11-15, 2.29 2.49 2.70 for MELD 16-20, 5.30 5.72 6.16 for MELD 21-25, 15.12 16.35 17.67 for MELD 26-30; 39.26 43.21 47.55 for MELD 31-34; 120.04 128.25 137.02 for MELD 35-40). As a result, candidates with the highest MELD gained the most life years after LT: 0.2, 1.5, 3.5, 5.8, 6.9, 7.2 years for MELD 11-15, 16-20, 21-25, 26-30, 31-34, 35-40, respectively. Therefore, prioritizing candidates by MELD remains a simple, effective strategy for prioritizing candidates with a higher transplant survival benefit over those with lower survival benefit.
KW - classification systems: Model for End-stage Liver Disease (MELD)
KW - clinical research/practice
KW - health services and outcomes research
KW - liver disease
KW - liver transplantation/hepatology
KW - organ allocation
KW - organ procurement and allocation
KW - organ transplantation in general
KW - patient survival
KW - registry/registry analysis
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U2 - 10.1111/ajt.14660
DO - 10.1111/ajt.14660
M3 - Article
C2 - 29316310
AN - SCOPUS:85042151464
SN - 1600-6135
VL - 18
SP - 1231
EP - 1237
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 5
ER -