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Model for end-stage liver disease: did the new liver allocation policy affect waiting list mortality?
Arch Surg. 2007 Nov; 142(11):1079-85.AS

Abstract

OBJECTIVE

To examine the impact of the Model for End-stage Liver Disease (MELD) on waiting list mortality.

DESIGN

Interrupted time series with a nominal inception point of the intervention on February 27, 2002.

SETTING

United Network for Organ Sharing Standard Transplant Analysis and Research file data from March 1, 1999, to July 30, 2004.

PARTICIPANTS

All adult candidates on the waiting list for liver transplantation in the United States during the study period.

INTERVENTION

Implementation of the MELD policy.

MAIN OUTCOME MEASURES

Waiting list mortality, waiting time to transplantation, number of new registrants, and posttransplantation survival.

RESULTS

Although no preintervention trend was identified, the policy change was associated with an immediate effect of increasing waiting list mortality by 2.2 deaths per 1000 registrants per month (from approximately 11 to 13 deaths per 1000 registrants per month; 95% confidence interval [CI], 1.1 to 3.4; P = .001) followed by a postintervention decline in waiting list mortality over time (-0.09 death per 1000 registrants per month; 95% CI, -0.16 to -0.03; P <.001). An immediate effect of decreased waiting time was also noted (from approximately 294 to 250 days; -44.4 days; 95% CI, -77.1 to -11.7 days; P <.001), which reached a new, lower postintervention steady state. The intervention had no effect on the number of new registrants listed per month or on 3- and 6-month posttransplantation survival.

CONCLUSION

After an initial increase in waiting list mortality, the implementation of the MELD-based allocation policy was associated with an overall decline in waiting list mortality and time to transplantation.

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Authors+Show Affiliations

Austin MT
Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Poulose BK
No affiliation info available
Ray WA
No affiliation info available
Arbogast PG
No affiliation info available
Feurer ID
No affiliation info available
Pinson CW
No affiliation info available

MeSH

AdultFemaleHealth Care RationingHealth PolicyHealth Services AccessibilityHumansKidney Failure, ChronicLiver TransplantationMaleMiddle AgedModels, BiologicalPatient SelectionSeverity of Illness IndexSurvival AnalysisTime FactorsTissue and Organ ProcurementUnited StatesWaiting Lists

Pub Type(s)

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

Language

eng

PubMed ID

18025337

Citation

Austin, Mary T., et al. "Model for End-stage Liver Disease: Did the New Liver Allocation Policy Affect Waiting List Mortality?" Archives of Surgery (Chicago, Ill. : 1960), vol. 142, no. 11, 2007, pp. 1079-85.
Austin MT, Poulose BK, Ray WA, et al. Model for end-stage liver disease: did the new liver allocation policy affect waiting list mortality? Arch Surg. 2007;142(11):1079-85.
Austin, M. T., Poulose, B. K., Ray, W. A., Arbogast, P. G., Feurer, I. D., & Pinson, C. W. (2007). Model for end-stage liver disease: did the new liver allocation policy affect waiting list mortality? Archives of Surgery (Chicago, Ill. : 1960), 142(11), 1079-85.
Austin MT, et al. Model for End-stage Liver Disease: Did the New Liver Allocation Policy Affect Waiting List Mortality. Arch Surg. 2007;142(11):1079-85. PubMed PMID: 18025337.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Model for end-stage liver disease: did the new liver allocation policy affect waiting list mortality? AU - Austin,Mary T, AU - Poulose,Benjamin K, AU - Ray,Wayne A, AU - Arbogast,Patrick G, AU - Feurer,Irene D, AU - Pinson,C Wright, PY - 2007/11/21/pubmed PY - 2007/12/6/medline PY - 2007/11/21/entrez SP - 1079 EP - 85 JF - Archives of surgery (Chicago, Ill. : 1960) JO - Arch Surg VL - 142 IS - 11 N2 - OBJECTIVE: To examine the impact of the Model for End-stage Liver Disease (MELD) on waiting list mortality. DESIGN: Interrupted time series with a nominal inception point of the intervention on February 27, 2002. SETTING: United Network for Organ Sharing Standard Transplant Analysis and Research file data from March 1, 1999, to July 30, 2004. PARTICIPANTS: All adult candidates on the waiting list for liver transplantation in the United States during the study period. INTERVENTION: Implementation of the MELD policy. MAIN OUTCOME MEASURES: Waiting list mortality, waiting time to transplantation, number of new registrants, and posttransplantation survival. RESULTS: Although no preintervention trend was identified, the policy change was associated with an immediate effect of increasing waiting list mortality by 2.2 deaths per 1000 registrants per month (from approximately 11 to 13 deaths per 1000 registrants per month; 95% confidence interval [CI], 1.1 to 3.4; P = .001) followed by a postintervention decline in waiting list mortality over time (-0.09 death per 1000 registrants per month; 95% CI, -0.16 to -0.03; P <.001). An immediate effect of decreased waiting time was also noted (from approximately 294 to 250 days; -44.4 days; 95% CI, -77.1 to -11.7 days; P <.001), which reached a new, lower postintervention steady state. The intervention had no effect on the number of new registrants listed per month or on 3- and 6-month posttransplantation survival. CONCLUSION: After an initial increase in waiting list mortality, the implementation of the MELD-based allocation policy was associated with an overall decline in waiting list mortality and time to transplantation. SN - 1538-3644 UR - https://www.unboundmedicine.com/medline/citation/18025337/Model_for_end_stage_liver_disease:_did_the_new_liver_allocation_policy_affect_waiting_list_mortality L2 - https://jamanetwork.com/journals/jamasurgery/fullarticle/10.1001/archsurg.142.11.1079 DB - PRIME DP - Unbound Medicine ER -