Building a Utility-based Liver Allocation Model in Preparation for Continuous Distribution

Kling, C; Perkins, James D.; Biggins, Scott W.; Wall, Anji; Reyes, Jorgé

doi:10.1097/txd.0000000000001282

Cited by 5 publications

(1 citation statement)

References 20 publications

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“…However, care must be taken to thoroughly evaluate the ethical considerations of the models used to assist decision-making. Kling et al 18 modeled a utility-only allocation system for LT. This model optimizes long-term survival instead of waitlist survival and disadvantages older patients so much that patients aged >60 y would vastly be excluded from transplantation.…”

Section: Discussionmentioning

confidence: 99%

Impact of Recipient Age at Liver Transplant on Long-term Outcomes

et al. 2022

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Background. The age of a liver transplant (LT) candidate is one of many variables used in the transplant selection process. Most research about the age at transplant has used prespecified age ranges or categories in assessing associations with transplant outcomes. However, there is a lack of knowledge about the age at transplant and survival. This study aimed to examine associations of age at transplant as a continuous variable, in conjunction with other patient and disease-related factors, with patient and graft survival after LT. Methods. We used the Standard Transplant Analysis and Research data to identify LT recipients between January 2002 and June 2018. Cox regression models with a restricted cubic spline term for age examined associations with graft and patient survival after LT. We assessed the interactions of age with recipients' sex, race/ethnicity, region, indication for transplant, body mass index, model for endstage liver disease score, diabetes, functional status at transplant, and donor risk index. Results. Age at the time of LT showed a nonlinear association with both graft and patient survival. Each demographic, clinical, transplant-related, and donor-related factor influenced these relationships differently. Conclusions. Our results suggest that some older LT candidates may be better than some younger candidates and that clinicians should not exclusively use age to determine who receives LT.

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Section: Discussionmentioning

confidence: 99%

Impact of Recipient Age at Liver Transplant on Long-term Outcomes

et al. 2022

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Common definitions and variables are needed for the United States to join the conversation on acute-on-chronic liver failure

Ge,

Kim,

Kwong

2024

American Journal of Transplantation

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Body Size Remains the Major Source of Sex Disparity Despite Updated Liver Transplant Allocation Policies

Tanaka,

Ross-Driscoll,

Pancholia

et al. 2024

Transplantation

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Background. Efforts to address US liver transplant (LT) access inequities continue, yet disparities linked to candidate traits persist. Methods. Analyzing national registry data pre- and post-Acuity Circle (AC) policy, our study assessed the impact of low body surface area (BSA) on LT waitlist mortality. The outcomes of LT candidates listed in the pre-AC era (n = 39 227) and post-AC (n = 38 443) were compared for patients with low BSA (22.9% pre-AC and 23.3% post-AC). Results. Fine-Gray competing risk models highlighted that candidates with low BSA had a lower likelihood of LT both pre-AC (hazard ratio [HR] 0.93; 95% confidence interval [CI], 0.92-0.95) and post-AC (HR 0.96; 95% CI, 0.94-0.98), with minimal improvement in waitlist mortality/dropout risk from pre-AC (HR 1.15; 95% CI, 1.09-1.21) to post-AC (HR 1.13; 95% CI, 1.06-1.19). Findings were mostly reaffirmed by Cox regression models incorporating the trajectory of Model for End-stage Liver Disease (MELD) scores as time-dependent covariates. Regions 3, 5, and 7 showed notable LT waitlist disparities among low BSA patients post-AC policy. Causal mediation analysis revealed that low BSA and the difference between MELD-sodium and MELD 3.0 (MELD_D, as a proxy for the potential impact of the introduction of MELD 3.0) largely explained the sex disparity in AC allocation (percent mediated 90.4). Conclusions. LT waitlist disparities for female candidates persist, largely mediated by small body size. Although MELD 3.0 may reduce some disparities, further body size adjustments for in allocation models are justified.

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Building a Utility-based Liver Allocation Model in Preparation for Continuous Distribution

Cited by 5 publications

References 20 publications

Impact of Recipient Age at Liver Transplant on Long-term Outcomes

Impact of Recipient Age at Liver Transplant on Long-term Outcomes

Common definitions and variables are needed for the United States to join the conversation on acute-on-chronic liver failure

Body Size Remains the Major Source of Sex Disparity Despite Updated Liver Transplant Allocation Policies

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