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Waiting list removal rates among patients with chronic and malignant liver diseases.
Am J Transplant. 2006 Jun; 6(6):1416-21.AJ

Abstract

Equitable liver allocation should ensure that nonelective removal rates are fairly distributed among waiting candidates. We compared removal rates for adults entered with nonmalignant (NM) (N = 9379) and hepatocellular cancer (HCC) (N = 2052) diagnoses on the Organ Procurement and Transplantation Network (OPTN) list between April 30, 2003, and December 31, 2004. Unadjusted removal rates for NM vs. HCC diagnoses were 9.4% vs. 8.7%, 13.5% vs. 16.9% and 19.1% vs. 31.8% at 90, 180 and 365 days, respectively after listing. For NM candidates, model for end-stage liver disease (MELD) score (RR = 1.16), age (RR = 1.03) and metabolic disease diagnoses (RR = 1.66) had higher risks of removal; and PSC (RR = 0.62) and alcoholic cirrhosis (RR = 0.82) had lower risks of removal. For HCC candidates, MELD score at listing (RR = 1.09), AFP (RR = 1.02), maximum tumor size (RR = 1.16) and age at listing (RR = 1.02) had increased risks of removal. The equation 1 - 0.920 exp[0.09369 (MELD at listing - 12.48) + 0.00193 (AFP - 97.4) + 0.1505 (maximum tumor size - 2.59) defined the probability of dropout for HCC candidates within 90 days of listing. We conclude that factors associated with the risk of removal for HCC are different from NM candidates, although MELD score at listing remains the most predictive for both groups. Liver transplant candidates with HCC may be prioritized using a risk score analogous to the MELD score.

Authors+Show Affiliations

Division of Transplantation, Department of Surgery, Tufts-New England Medical Center, Boston, Massachusetts, USA. rfreeman@tuftsNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16686765

Citation

Freeman, R B., et al. "Waiting List Removal Rates Among Patients With Chronic and Malignant Liver Diseases." American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, vol. 6, no. 6, 2006, pp. 1416-21.
Freeman RB, Edwards EB, Harper AM. Waiting list removal rates among patients with chronic and malignant liver diseases. Am J Transplant. 2006;6(6):1416-21.
Freeman, R. B., Edwards, E. B., & Harper, A. M. (2006). Waiting list removal rates among patients with chronic and malignant liver diseases. American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 6(6), 1416-21.
Freeman RB, Edwards EB, Harper AM. Waiting List Removal Rates Among Patients With Chronic and Malignant Liver Diseases. Am J Transplant. 2006;6(6):1416-21. PubMed PMID: 16686765.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Waiting list removal rates among patients with chronic and malignant liver diseases. AU - Freeman,R B, AU - Edwards,E B, AU - Harper,A M, PY - 2006/5/12/pubmed PY - 2006/10/26/medline PY - 2006/5/12/entrez SP - 1416 EP - 21 JF - American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons JO - Am J Transplant VL - 6 IS - 6 N2 - Equitable liver allocation should ensure that nonelective removal rates are fairly distributed among waiting candidates. We compared removal rates for adults entered with nonmalignant (NM) (N = 9379) and hepatocellular cancer (HCC) (N = 2052) diagnoses on the Organ Procurement and Transplantation Network (OPTN) list between April 30, 2003, and December 31, 2004. Unadjusted removal rates for NM vs. HCC diagnoses were 9.4% vs. 8.7%, 13.5% vs. 16.9% and 19.1% vs. 31.8% at 90, 180 and 365 days, respectively after listing. For NM candidates, model for end-stage liver disease (MELD) score (RR = 1.16), age (RR = 1.03) and metabolic disease diagnoses (RR = 1.66) had higher risks of removal; and PSC (RR = 0.62) and alcoholic cirrhosis (RR = 0.82) had lower risks of removal. For HCC candidates, MELD score at listing (RR = 1.09), AFP (RR = 1.02), maximum tumor size (RR = 1.16) and age at listing (RR = 1.02) had increased risks of removal. The equation 1 - 0.920 exp[0.09369 (MELD at listing - 12.48) + 0.00193 (AFP - 97.4) + 0.1505 (maximum tumor size - 2.59) defined the probability of dropout for HCC candidates within 90 days of listing. We conclude that factors associated with the risk of removal for HCC are different from NM candidates, although MELD score at listing remains the most predictive for both groups. Liver transplant candidates with HCC may be prioritized using a risk score analogous to the MELD score. SN - 1600-6135 UR - https://www.unboundmedicine.com/medline/citation/16686765/Waiting_list_removal_rates_among_patients_with_chronic_and_malignant_liver_diseases_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1600-6135&date=2006&volume=6&issue=6&spage=1416 DB - PRIME DP - Unbound Medicine ER -