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Liver transplantation for hepatocellular carcinoma: the MELD impact.
Liver Transpl. 2004 Jan; 10(1):36-41.LT

Abstract

The new allocation policy of the United Network of Organ Sharing (UNOS) based on the model for end-stage liver disease (MELD) gives candidates with stage T1 or stage T2 hepatocellular carcinoma (HCC) a priority MELD score beyond their degree of hepatic decompensation. The aim of this study was to determine the impact of the new allocation policy on HCC candidates before and after the institution of MELD. The UNOS database was reviewed for all HCC candidates listed between July 1999 and July 2002. The candidates were grouped by two time periods, based on the date of implementation of new allocation policy of February 27, 2002. Pre-MELD candidates were listed for deceased donor liver transplantation (DDLT) before February 27,2002, and post-MELD candidates were listed after February 27, 2002. Candidates were compared by incidence of DDLT, time to DDLT, and dropout rate from the waiting list because of clinical deterioration or death, and survival while waiting and after DDLT. Incidence rates calculated for pre-MELD and post-MELD periods were expressed in person years. During the study, 2,074 HCC candidates were listed for DDLT in the UNOS database. The DDLT incidence rate was 0.439 transplant/person years pre-MELD and 1.454 transplant/person years post-MELD (P < 0.001). The time to DDLT was 2.28 years pre-MELD and 0.69 years post-MELD (P < 0.001). The 5-month dropout rate was 16.5% pre-MELD and 8.5% post-MELD (P < 0.001). The 5-month waiting-list survival was 90.3% pre-MELD and 95.7% post-MELD (P < 0.001). The 5-month survival after DDLT was similar for both time periods. The new allocation policy has led to an increased incidence rate of DDLT in HCC candidates. Furthermore, the 5-month dropout rate has decreased significantly. In addition, 5-month survival while waiting has increased in the post-MELD period. Thus, the new MELD-based allocation policy has benefited HCC candidates.

Authors+Show Affiliations

Division of Transplantation Medicine, Mayo Clinic, Scottsdale, AZ, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14755775

Citation

Sharma, Pratima, et al. "Liver Transplantation for Hepatocellular Carcinoma: the MELD Impact." Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 10, no. 1, 2004, pp. 36-41.
Sharma P, Balan V, Hernandez JL, et al. Liver transplantation for hepatocellular carcinoma: the MELD impact. Liver Transpl. 2004;10(1):36-41.
Sharma, P., Balan, V., Hernandez, J. L., Harper, A. M., Edwards, E. B., Rodriguez-Luna, H., Byrne, T., Vargas, H. E., Mulligan, D., Rakela, J., & Wiesner, R. H. (2004). Liver transplantation for hepatocellular carcinoma: the MELD impact. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 10(1), 36-41.
Sharma P, et al. Liver Transplantation for Hepatocellular Carcinoma: the MELD Impact. Liver Transpl. 2004;10(1):36-41. PubMed PMID: 14755775.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Liver transplantation for hepatocellular carcinoma: the MELD impact. AU - Sharma,Pratima, AU - Balan,Vijayan, AU - Hernandez,Jose L, AU - Harper,Ann M, AU - Edwards,Erick B, AU - Rodriguez-Luna,Hector, AU - Byrne,Thomas, AU - Vargas,Hugo E, AU - Mulligan,David, AU - Rakela,Jorge, AU - Wiesner,Russell H, PY - 2004/2/3/pubmed PY - 2004/9/11/medline PY - 2004/2/3/entrez SP - 36 EP - 41 JF - Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society JO - Liver Transpl VL - 10 IS - 1 N2 - The new allocation policy of the United Network of Organ Sharing (UNOS) based on the model for end-stage liver disease (MELD) gives candidates with stage T1 or stage T2 hepatocellular carcinoma (HCC) a priority MELD score beyond their degree of hepatic decompensation. The aim of this study was to determine the impact of the new allocation policy on HCC candidates before and after the institution of MELD. The UNOS database was reviewed for all HCC candidates listed between July 1999 and July 2002. The candidates were grouped by two time periods, based on the date of implementation of new allocation policy of February 27, 2002. Pre-MELD candidates were listed for deceased donor liver transplantation (DDLT) before February 27,2002, and post-MELD candidates were listed after February 27, 2002. Candidates were compared by incidence of DDLT, time to DDLT, and dropout rate from the waiting list because of clinical deterioration or death, and survival while waiting and after DDLT. Incidence rates calculated for pre-MELD and post-MELD periods were expressed in person years. During the study, 2,074 HCC candidates were listed for DDLT in the UNOS database. The DDLT incidence rate was 0.439 transplant/person years pre-MELD and 1.454 transplant/person years post-MELD (P < 0.001). The time to DDLT was 2.28 years pre-MELD and 0.69 years post-MELD (P < 0.001). The 5-month dropout rate was 16.5% pre-MELD and 8.5% post-MELD (P < 0.001). The 5-month waiting-list survival was 90.3% pre-MELD and 95.7% post-MELD (P < 0.001). The 5-month survival after DDLT was similar for both time periods. The new allocation policy has led to an increased incidence rate of DDLT in HCC candidates. Furthermore, the 5-month dropout rate has decreased significantly. In addition, 5-month survival while waiting has increased in the post-MELD period. Thus, the new MELD-based allocation policy has benefited HCC candidates. SN - 1527-6465 UR - https://www.unboundmedicine.com/medline/citation/14755775/Liver_transplantation_for_hepatocellular_carcinoma:_the_MELD_impact_ L2 - https://doi.org/10.1002/lt.20012 DB - PRIME DP - Unbound Medicine ER -