TY - JOUR
T1 - MELD is MELD is MELD? Transplant center–level variation in waitlist mortality for candidates with the same biological MELD
AU - Ishaque, Tanveen
AU - Kernodle, Amber B.
AU - Motter, Jennifer D.
AU - Jackson, Kyle R.
AU - Chiang, Teresa P.
AU - Getsin, Samantha
AU - Boyarsky, Brian J.
AU - Garonzik-Wang, Jacqueline
AU - Gentry, Sommer E.
AU - Segev, Dorry L.
AU - Massie, Allan B.
N1 - Publisher Copyright:
© 2021 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.
PY - 2021/10
Y1 - 2021/10
N2 - Recently, model for end-stage liver disease (MELD)-based liver allocation in the United States has been questioned based on concerns that waitlist mortality for a given biologic MELD (bMELD), calculated using laboratory values alone, might be higher at certain centers in certain locations across the country. Therefore, we aimed to quantify the center-level variation in bMELD-predicted mortality risk. Using Scientific Registry of Transplant Recipients (SRTR) data from January 2015 to December 2019, we modeled mortality risk in 33 260 adult, first-time waitlisted candidates from 120 centers using multilevel Poisson regression, adjusting for sex, and time-varying age and bMELD. We calculated a "MELD correction factor" using each center's random intercept and bMELD coefficient. A MELD correction factor of +1 means that center's candidates have a higher-than-average bMELD-predicted mortality risk equivalent to 1 bMELD point. We found that the “MELD correction factor” median (IQR) was 0.03 (−0.47, 0.52), indicating almost no center-level variation. The number of centers with “MELD correction factors” within ±0.5 points, and between ±0.5–± 1, ±1.0–±1.5, and ±1.5–±2.0 points was 62, 41, 13, and 4, respectively. No centers had waitlisted candidates with a higher-than-average bMELD-predicted mortality risk beyond ±2 bMELD points. Given that bMELD similarly predicts waitlist mortality at centers across the country, our results support continued MELD-based prioritization of waitlisted candidates irrespective of center.
AB - Recently, model for end-stage liver disease (MELD)-based liver allocation in the United States has been questioned based on concerns that waitlist mortality for a given biologic MELD (bMELD), calculated using laboratory values alone, might be higher at certain centers in certain locations across the country. Therefore, we aimed to quantify the center-level variation in bMELD-predicted mortality risk. Using Scientific Registry of Transplant Recipients (SRTR) data from January 2015 to December 2019, we modeled mortality risk in 33 260 adult, first-time waitlisted candidates from 120 centers using multilevel Poisson regression, adjusting for sex, and time-varying age and bMELD. We calculated a "MELD correction factor" using each center's random intercept and bMELD coefficient. A MELD correction factor of +1 means that center's candidates have a higher-than-average bMELD-predicted mortality risk equivalent to 1 bMELD point. We found that the “MELD correction factor” median (IQR) was 0.03 (−0.47, 0.52), indicating almost no center-level variation. The number of centers with “MELD correction factors” within ±0.5 points, and between ±0.5–± 1, ±1.0–±1.5, and ±1.5–±2.0 points was 62, 41, 13, and 4, respectively. No centers had waitlisted candidates with a higher-than-average bMELD-predicted mortality risk beyond ±2 bMELD points. Given that bMELD similarly predicts waitlist mortality at centers across the country, our results support continued MELD-based prioritization of waitlisted candidates irrespective of center.
KW - Organ Procurement and Transplantation Network (OPTN)
KW - donors and donation: deceased
KW - ethics and public policy
KW - health services and outcomes research
KW - liver transplantation/hepatology
KW - organ allocation
KW - organ procurement and allocation
KW - organ procurement organization
KW - organ transplantation in general
KW - waitlist management
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U2 - 10.1111/ajt.16603
DO - 10.1111/ajt.16603
M3 - Article
C2 - 33870635
AN - SCOPUS:85105807105
SN - 1600-6135
VL - 21
SP - 3305
EP - 3311
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 10
ER -