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Liver transplantation for hepatocellular carcinoma: lessons from the first year under the Model of End-Stage Liver Disease (MELD) organ allocation policy.
Liver Transpl. 2004 May; 10(5):621-30.LT

Abstract

We examined the impact of the Model for End-Stage Liver Disease (MELD) organ allocation scheme on 44 patients with hepatocellular carcinoma (HCC) awaiting orthotopic liver transplantation (OLT) between February 2002 and January 2003, and compared the outcome with 58 patients listed in the 4 years before MELD implementation. Patients undergoing living-donor liver transplantation were excluded. The Kaplan-Meier probabilities for OLT at 3, 6, and up to 8.5 months were 22.5%, 64.0%, and 88.0%, respectively, under MELD versus 17.2%, 24.7%, and 35.8% at 3, 6 and 9 months, respectively, in the pre-MELD group (P =.0006). In Cox regression analysis, non-O blood group (hazard ratio 2.5; P =.047 versus blood group O) and 3 tumor nodules (hazard ratio 5.5; P =.005) were associated with a significantly higher probability for OLT under MELD. The probabilities of dropout were 5.6% at 6 and 8.5 months under MELD versus 7.2% and 37.8% at 6 and 12 months, respectively, in the pre-MELD group (P =.74). The lack of a significant difference in dropout may be due to low dropout rates in the first 6 months in either group. No HCC was found in the explant in 1 patient from each group. In conclusion, the HCC-adjusted MELD system significantly improved the probability of timely OLT, albeit a significant disadvantage for blood group O was evident. Compared with preliminary UNOS data, in which 90% of patients with HCC have received OLT within 3 months, our results reflect the wide regional variation in the impact of MELD.

Authors+Show Affiliations

Department of Medicine, Division of Gastroenterology, University of California, San Francisco, 94143-0538, USA. yaofyk@itsa.ucsf.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15108253

Citation

Yao, Francis Y., et al. "Liver Transplantation for Hepatocellular Carcinoma: Lessons From the First Year Under the Model of End-Stage Liver Disease (MELD) Organ Allocation Policy." Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 10, no. 5, 2004, pp. 621-30.
Yao FY, Bass NM, Ascher NL, et al. Liver transplantation for hepatocellular carcinoma: lessons from the first year under the Model of End-Stage Liver Disease (MELD) organ allocation policy. Liver Transpl. 2004;10(5):621-30.
Yao, F. Y., Bass, N. M., Ascher, N. L., & Roberts, J. P. (2004). Liver transplantation for hepatocellular carcinoma: lessons from the first year under the Model of End-Stage Liver Disease (MELD) organ allocation policy. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 10(5), 621-30.
Yao FY, et al. Liver Transplantation for Hepatocellular Carcinoma: Lessons From the First Year Under the Model of End-Stage Liver Disease (MELD) Organ Allocation Policy. Liver Transpl. 2004;10(5):621-30. PubMed PMID: 15108253.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Liver transplantation for hepatocellular carcinoma: lessons from the first year under the Model of End-Stage Liver Disease (MELD) organ allocation policy. AU - Yao,Francis Y, AU - Bass,Nathan M, AU - Ascher,Nancy L, AU - Roberts,John P, PY - 2004/4/27/pubmed PY - 2004/8/17/medline PY - 2004/4/27/entrez SP - 621 EP - 30 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 - 5 N2 - We examined the impact of the Model for End-Stage Liver Disease (MELD) organ allocation scheme on 44 patients with hepatocellular carcinoma (HCC) awaiting orthotopic liver transplantation (OLT) between February 2002 and January 2003, and compared the outcome with 58 patients listed in the 4 years before MELD implementation. Patients undergoing living-donor liver transplantation were excluded. The Kaplan-Meier probabilities for OLT at 3, 6, and up to 8.5 months were 22.5%, 64.0%, and 88.0%, respectively, under MELD versus 17.2%, 24.7%, and 35.8% at 3, 6 and 9 months, respectively, in the pre-MELD group (P =.0006). In Cox regression analysis, non-O blood group (hazard ratio 2.5; P =.047 versus blood group O) and 3 tumor nodules (hazard ratio 5.5; P =.005) were associated with a significantly higher probability for OLT under MELD. The probabilities of dropout were 5.6% at 6 and 8.5 months under MELD versus 7.2% and 37.8% at 6 and 12 months, respectively, in the pre-MELD group (P =.74). The lack of a significant difference in dropout may be due to low dropout rates in the first 6 months in either group. No HCC was found in the explant in 1 patient from each group. In conclusion, the HCC-adjusted MELD system significantly improved the probability of timely OLT, albeit a significant disadvantage for blood group O was evident. Compared with preliminary UNOS data, in which 90% of patients with HCC have received OLT within 3 months, our results reflect the wide regional variation in the impact of MELD. SN - 1527-6465 UR - https://www.unboundmedicine.com/medline/citation/15108253/Liver_transplantation_for_hepatocellular_carcinoma:_lessons_from_the_first_year_under_the_Model_of_End_Stage_Liver_Disease__MELD__organ_allocation_policy_ L2 - https://doi.org/10.1002/lt.20159 DB - PRIME DP - Unbound Medicine ER -