Is waiting time a measure of access to liver transplantation? Is shorter necessarily better?†

Freeman, Richard B.

doi:10.1002/hep.21865

Cited by 8 publications

(4 citation statements)

References 14 publications

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“…Under the system waitlist mortality continued to increase. 6–8 In studies that correlated waiting time and risk of mortality, waiting time was shown to be a poor metric for disease severity. 9 In 1999, the Institute of Medicine and the US Department of Health and Human Services issued a mandate to the liver transplant community to design an organ allocation system that de-emphasized waiting time and set allocation priorities based on the severity of liver disease and risk of mortality.…”

Section: A Development Of the Meld Scorementioning

confidence: 99%

Model for End-Stage Liver Disease: End of the First Decade

Asrani

Kim

2011

Clinics in Liver Disease

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Synopsis In February 2002 the Model for End Stage Liver Disease score (MELD) was adopted as the basis for allocation of liver allografts for transplantation (LT) in the United States. Implementation of the MELD score led to a reduction in waiting list registration and waitlist mortality and an increase in deceased donor transplants. The MELD score, as an objective scale of disease severity, has been used in the management of patients with chronic liver disease in the non-transplant setting. Several models have been proposed to refine and improve the MELD score. This includes measurement of serial MELD scores, addition of variables (e.g. serum sodium), or re weighting components of the MELD score. We believe that the MELD score will be used as a template to improve upon as an objective gauge of disease severity and a metric to optimize allocation of scarce donor organs for liver transplantation for the next decade and beyond.

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Section: A Development Of the Meld Scorementioning

confidence: 99%

Model for End-Stage Liver Disease: End of the First Decade

Asrani

Kim

2011

Clinics in Liver Disease

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“…This time period was chosen because it coincided with the implementation of the Model for End Stage Liver Disease (MELD) criteria, which grants exception points to patients with a presumed diagnosis of HCC, thereby expediting the ability of patients with HCC to undergo TXP. 19 Under UNOS criteria, a pre-TXP tissue diagnosis of HCC is not required, and patients can be deemed to have HCC and receive exception points based on suspicious imaging and/or elevated alphafetoprotein (AFP) levels.…”

Section: Methodsmentioning

confidence: 99%

Comparative Analysis of Outcome in Patients With Hepatocellular Carcinoma Exceeding the Milan Criteria Treated With Liver Transplantation Versus Partial Hepatectomy

Canter

Patel

Kennedy

et al. 2011

American Journal of Clinical Oncology

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“…CTP components also lacked statistical validity (e.g., equal weights for all elements, for example hyperbilirubinemia versus grade II hepatic encephalopathy). Under the system, waiting-list mortality and waiting time continued to increase [3][4][5] and a more equitable and efficient system that reduced the emphasis on waiting time and set allocation priorities on the basis of the severity of the liver disease and the risk of mortality was desired [6].…”

Section: Development Of the Meld Scorementioning

confidence: 99%

Model for end-stage liver disease score and MELD exceptions: 15 years later

Asrani

Kamath

2015

Hepatol Int

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The model for end-stage liver disease (MELD) score has been used as an objective scale of disease severity for management of patients with end-stage liver disease; it currently serves as the basis of an urgency-based organ-allocation policy in several countries. Implementation of the MELD score led to a reduction in waiting-list registration and waiting-list mortality and an increase in the number of deceased-donor transplants without adversely affecting long-term outcomes after liver transplantation (LT). The MELD score has been used for management of non-transplant patients with chronic liver disease. MELD exceptions serve as a mechanism to advance the needs of subsets of patients with liver disease not adequately addressed by MELD-based organ allocation. Several models have been proposed to refine and improve the MELD score as the environment within which it operates continues to evolve toward transplantation for sicker patients. The MELD score continues to serve and be used as a template to improve upon as an objective gauge of disease severity and as a metric enabling optimization of allocation of scarce donor organs for LT.

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Is waiting time a measure of access to liver transplantation? Is shorter necessarily better?†

Cited by 8 publications

References 14 publications

Model for End-Stage Liver Disease: End of the First Decade

Model for End-Stage Liver Disease: End of the First Decade

Comparative Analysis of Outcome in Patients With Hepatocellular Carcinoma Exceeding the Milan Criteria Treated With Liver Transplantation Versus Partial Hepatectomy

Model for end-stage liver disease score and MELD exceptions: 15 years later

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