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A new priority policy for patients with hepatocellular carcinoma awaiting liver transplantation within the model for end-stage liver disease system.
Liver Transpl. 2007 Jun; 13(6):857-66.LT

Abstract

The best prioritization of patients with hepatocellular carcinoma (HCC) waiting for liver transplantation under the model for end-stage liver disease (MELD) allocation system is still being debated. We analyzed the impact of a MELD adjustment for HCC, which consisted of the addition of an extra score (based on the HCC stage and waiting time) to the native MELD score. The outcome was analyzed for 301 patients with chronic liver disease listed for liver transplantation between March 1, 2001 and February 28, 2003 [United Network for Organ Sharing (UNOS)-Child-Turcotte-Pugh (CTP) era, 163 patients, 28.8% with HCC] and between March 1, 2003 and February 28, 2004 (HCC-MELD era, 138 patients, 29.7% with HCC). In the HCC-MELD era, the cumulative dropout risk at 6 months was 17.6% for patients with HCC versus 22.3% for those patients without HCC (P = NS), similar to that in the UNOS-CTP era. The cumulative probability of transplantation at 6 months was 70.3% versus 39.0% (P = 0.005), being higher than that in the UNOS-CTP era for patients with HCC (P = 0.02). At the end of the HCC-MELD era, 12 patients with HCC (29.3%) versus 57 without HCC (58.8%) were still on the list (P = 0.001). Both native and adjusted MELD scores were higher (P < 0.05) and progressed more in patients with HCC who dropped out than in those who underwent transplantation or remained on the list (the initial-final native MELD scores were 17.3-23.1, 15.5-15.6, and 12.8-14.1, respectively). The patients without HCC remaining on the list showed stable MELD scores (initial-final: 15.1-15.4). In conclusion, the present data support the strategy of including the native MELD scores in the allocation system for HCC. This model allows the timely transplantation of patients with HCC without severely affecting the outcome of patients without HCC.

Authors+Show Affiliations

Department of Internal Medicine and Gastroenterology, Sant'Orsola-Malpighi Hospital, Bologna, Italy. fabio.piscaglia@unibo.itNo 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

17539006

Citation

Piscaglia, Fabio, et al. "A New Priority Policy for Patients With Hepatocellular Carcinoma Awaiting Liver Transplantation Within the Model for End-stage Liver Disease System." Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 13, no. 6, 2007, pp. 857-66.
Piscaglia F, Camaggi V, Ravaioli M, et al. A new priority policy for patients with hepatocellular carcinoma awaiting liver transplantation within the model for end-stage liver disease system. Liver Transpl. 2007;13(6):857-66.
Piscaglia, F., Camaggi, V., Ravaioli, M., Grazi, G. L., Zanello, M., Leoni, S., Ballardini, G., Cavrini, G., Pinna, A. D., & Bolondi, L. (2007). A new priority policy for patients with hepatocellular carcinoma awaiting liver transplantation within the model for end-stage liver disease system. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 13(6), 857-66.
Piscaglia F, et al. A New Priority Policy for Patients With Hepatocellular Carcinoma Awaiting Liver Transplantation Within the Model for End-stage Liver Disease System. Liver Transpl. 2007;13(6):857-66. PubMed PMID: 17539006.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A new priority policy for patients with hepatocellular carcinoma awaiting liver transplantation within the model for end-stage liver disease system. AU - Piscaglia,Fabio, AU - Camaggi,Valeria, AU - Ravaioli,Matteo, AU - Grazi,Gian Luca, AU - Zanello,Matteo, AU - Leoni,Simona, AU - Ballardini,Giorgio, AU - Cavrini,Giulia, AU - Pinna,Antonio Daniele, AU - Bolondi,Luigi, PY - 2007/6/1/pubmed PY - 2007/8/19/medline PY - 2007/6/1/entrez SP - 857 EP - 66 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 - 13 IS - 6 N2 - The best prioritization of patients with hepatocellular carcinoma (HCC) waiting for liver transplantation under the model for end-stage liver disease (MELD) allocation system is still being debated. We analyzed the impact of a MELD adjustment for HCC, which consisted of the addition of an extra score (based on the HCC stage and waiting time) to the native MELD score. The outcome was analyzed for 301 patients with chronic liver disease listed for liver transplantation between March 1, 2001 and February 28, 2003 [United Network for Organ Sharing (UNOS)-Child-Turcotte-Pugh (CTP) era, 163 patients, 28.8% with HCC] and between March 1, 2003 and February 28, 2004 (HCC-MELD era, 138 patients, 29.7% with HCC). In the HCC-MELD era, the cumulative dropout risk at 6 months was 17.6% for patients with HCC versus 22.3% for those patients without HCC (P = NS), similar to that in the UNOS-CTP era. The cumulative probability of transplantation at 6 months was 70.3% versus 39.0% (P = 0.005), being higher than that in the UNOS-CTP era for patients with HCC (P = 0.02). At the end of the HCC-MELD era, 12 patients with HCC (29.3%) versus 57 without HCC (58.8%) were still on the list (P = 0.001). Both native and adjusted MELD scores were higher (P < 0.05) and progressed more in patients with HCC who dropped out than in those who underwent transplantation or remained on the list (the initial-final native MELD scores were 17.3-23.1, 15.5-15.6, and 12.8-14.1, respectively). The patients without HCC remaining on the list showed stable MELD scores (initial-final: 15.1-15.4). In conclusion, the present data support the strategy of including the native MELD scores in the allocation system for HCC. This model allows the timely transplantation of patients with HCC without severely affecting the outcome of patients without HCC. SN - 1527-6465 UR - https://www.unboundmedicine.com/medline/citation/17539006/A_new_priority_policy_for_patients_with_hepatocellular_carcinoma_awaiting_liver_transplantation_within_the_model_for_end_stage_liver_disease_system_ L2 - https://doi.org/10.1002/lt.21155 DB - PRIME DP - Unbound Medicine ER -