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Liver transplantation in the MELD era: a single-center experience
Mankanwal Sachdev1, Jose L Hernandez, Pratima Sharma
1Division of Transplantation Medicine, Mayo Clinic, Scottsdale, Arizona, USA.
Abstract:
Model for Endstage Liver Disease (MELD) score has been used to allocate organs since February 2002. This policy allocates organs to candidates with regard to severity of their underlying liver disease except in the case of hepatocellular carcinoma (HCC) patients. The purpose of this study was to determine the impact of MELD on waiting times, dropout rates, and transplantation rates in all patients awaiting liver transplantation at our center. The records of all patients listed for liver transplantation between May 28, 1999, and February 27, 2004, at the Mayo Clinic, Scottsdale, Arizona, were reviewed. Candidates were grouped by two time periods as pre-MELD or post-MELD based on date of MELD implementation (February 27, 2002). The incidence of deceased donor liver transplantation (DDLT), waiting time to DDLT, dropout rate from the waiting list because of clinical deterioration or death, and survival while waiting for or after DDLT were determined for each group. Three hundred fifty-one patients were listed for liver transplantation (195 pre-MELD, 156 post-MELD) during the study period. HCC patients had an improved rate of transplantation after MELD (pre-MELD, 1.39 persons per year; post-MELD, 3.48 persons per year). In all groups, with the exception of hepatitis C virus, the transplantation rates were the same for both categories. The hepatitis C virus group also had improved transplantation rates in the post-MELD period. HCC candidates under the new allocation policy have an increased incidence of DDLT in our institution. However, this has not disadvantaged patients with non-HCC diagnoses. Thus, the new MELD-based allocation policy has benefited all candidates by allowing more timely transplants.
Insights
The Model for Endstage Liver Disease (MELD) score improved liver transplant wait times and outcomes for all patients, including those with hepatocellular carcinoma (HCC) and hepatitis C virus. This policy ensures more timely organ allocation without disadvantaging other diagnoses.
Area of Science:
- Hepatology
- Transplantation Medicine
- Public Health Policy
Background:
- The Model for Endstage Liver Disease (MELD) score has guided organ allocation since 2002.
- Current policy prioritizes liver disease severity, with exceptions for hepatocellular carcinoma (HCC) patients.
- Assessing MELD's impact on liver transplant candidates is crucial.
Purpose of the Study:
- To evaluate the effect of the MELD score on liver transplant waiting times.
- To determine changes in dropout rates among liver transplant candidates.
- To analyze transplantation rates before and after MELD implementation.
Main Methods:
- Retrospective review of liver transplant candidates listed between May 1999 and February 2004.
- Categorization of patients into pre-MELD and post-MELD groups based on allocation policy.
- Analysis of deceased donor liver transplantation (DDLT) incidence, waiting times, dropout rates, and survival.
Main Results:
- Liver transplantation rates increased for HCC patients post-MELD (1.39 to 3.48 per year).
- Hepatitis C virus patients also showed improved transplantation rates after MELD implementation.
- Transplantation rates remained consistent for most non-HCC, non-HCV groups.
Conclusions:
- The MELD-based allocation policy increased DDLT for HCC candidates.
- The policy did not negatively impact non-HCC diagnoses.
- The MELD system has successfully facilitated more timely liver transplants for all eligible candidates.
