Liver transplantation for hepatocellular carcinoma: The MELD impact

Pratima Sharma, Vijayan Balan, Jose L. Hernandez, Ann M. Harper, Erick B. Edwards, Hector Rodriguez-Luna, Thomas Byrne, Hugo E Vargas, David Mulligan, Jorge Rakela, Russell H. Wiesner

Research output: Contribution to journalArticle

205 Citations (Scopus)

Abstract

The new allocation policy of the United Network of Organ Sharing (UNOS) based on the model for end-stage liver disease (MELD) gives candidates with stage T1 or stage T2 hepatocellular carcinoma (HCC) a priority MELD score beyond their degree of hepatic decompensation. The aim of this study was to determine the impact of the new allocation policy on HCC candidates before and after the institution of MELD. The UNOS database was reviewed for all HCC candidates listed between July 1999 and July 2002. The candidates were grouped by two time periods, based on the date of implementation of new allocation policy of February 27, 2002. Pre-MELD candidates were listed for deceased donor liver transplantation (DDLT) before February 27, 2002, and post-MELD candidates were listed after February 27, 2002. Candidates were compared by incidence of DDLT, time to DDLT, and dropout rate from the waiting list because of clinical deterioration or death, and survival while waiting and after DDLT. Incidence rates calculated for pre-MELD and post-MELD periods were expressed in person years. During the study, 2,074 HCC candidates were listed for DDLT in the UNOS database. The DDLT incidence rate was 0.439 transplant/person years pre-MELD and 1.454 transplant/person years post-MELD (P < 0.001). The time to DDLT was 2.28 years pre-MELD and 0.69 years post-MELD (P < 0.001). The 5-month dropout rate was 16.5% pre-MELD and 8.5% post-MELD (P < 0.001). The 5-month waiting-list survival was 90.3% pre-MELD and 95.7% post-MELD (P < 0.001). The 5-month survival after DDLT was similar for both time periods. The new allocation policy has led to an increased incidence rate of DDLT in HCC candidates. Furthermore, the 5-month dropout rate has decreased significantly. In addition, 5-month survival while waiting has increased in the post-MELD period. Thus, the new MELD-based allocation policy has benefited HCC candidates.

Original languageEnglish (US)
Pages (from-to)36-41
Number of pages6
JournalLiver Transplantation
Volume10
Issue number1
DOIs
StatePublished - Jan 2004

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End Stage Liver Disease
Liver Transplantation
Hepatocellular Carcinoma
Waiting Lists
Survival
Incidence
Databases
Transplants

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Sharma, P., Balan, V., Hernandez, J. L., Harper, A. M., Edwards, E. B., Rodriguez-Luna, H., ... Wiesner, R. H. (2004). Liver transplantation for hepatocellular carcinoma: The MELD impact. Liver Transplantation, 10(1), 36-41. https://doi.org/10.1002/lt.20012

Liver transplantation for hepatocellular carcinoma : The MELD impact. / Sharma, Pratima; Balan, Vijayan; Hernandez, Jose L.; Harper, Ann M.; Edwards, Erick B.; Rodriguez-Luna, Hector; Byrne, Thomas; Vargas, Hugo E; Mulligan, David; Rakela, Jorge; Wiesner, Russell H.

In: Liver Transplantation, Vol. 10, No. 1, 01.2004, p. 36-41.

Research output: Contribution to journalArticle

Sharma, P, Balan, V, Hernandez, JL, Harper, AM, Edwards, EB, Rodriguez-Luna, H, Byrne, T, Vargas, HE, Mulligan, D, Rakela, J & Wiesner, RH 2004, 'Liver transplantation for hepatocellular carcinoma: The MELD impact', Liver Transplantation, vol. 10, no. 1, pp. 36-41. https://doi.org/10.1002/lt.20012
Sharma P, Balan V, Hernandez JL, Harper AM, Edwards EB, Rodriguez-Luna H et al. Liver transplantation for hepatocellular carcinoma: The MELD impact. Liver Transplantation. 2004 Jan;10(1):36-41. https://doi.org/10.1002/lt.20012
Sharma, Pratima ; Balan, Vijayan ; Hernandez, Jose L. ; Harper, Ann M. ; Edwards, Erick B. ; Rodriguez-Luna, Hector ; Byrne, Thomas ; Vargas, Hugo E ; Mulligan, David ; Rakela, Jorge ; Wiesner, Russell H. / Liver transplantation for hepatocellular carcinoma : The MELD impact. In: Liver Transplantation. 2004 ; Vol. 10, No. 1. pp. 36-41.
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abstract = "The new allocation policy of the United Network of Organ Sharing (UNOS) based on the model for end-stage liver disease (MELD) gives candidates with stage T1 or stage T2 hepatocellular carcinoma (HCC) a priority MELD score beyond their degree of hepatic decompensation. The aim of this study was to determine the impact of the new allocation policy on HCC candidates before and after the institution of MELD. The UNOS database was reviewed for all HCC candidates listed between July 1999 and July 2002. The candidates were grouped by two time periods, based on the date of implementation of new allocation policy of February 27, 2002. Pre-MELD candidates were listed for deceased donor liver transplantation (DDLT) before February 27, 2002, and post-MELD candidates were listed after February 27, 2002. Candidates were compared by incidence of DDLT, time to DDLT, and dropout rate from the waiting list because of clinical deterioration or death, and survival while waiting and after DDLT. Incidence rates calculated for pre-MELD and post-MELD periods were expressed in person years. During the study, 2,074 HCC candidates were listed for DDLT in the UNOS database. The DDLT incidence rate was 0.439 transplant/person years pre-MELD and 1.454 transplant/person years post-MELD (P < 0.001). The time to DDLT was 2.28 years pre-MELD and 0.69 years post-MELD (P < 0.001). The 5-month dropout rate was 16.5{\%} pre-MELD and 8.5{\%} post-MELD (P < 0.001). The 5-month waiting-list survival was 90.3{\%} pre-MELD and 95.7{\%} post-MELD (P < 0.001). The 5-month survival after DDLT was similar for both time periods. The new allocation policy has led to an increased incidence rate of DDLT in HCC candidates. Furthermore, the 5-month dropout rate has decreased significantly. In addition, 5-month survival while waiting has increased in the post-MELD period. Thus, the new MELD-based allocation policy has benefited HCC candidates.",
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AU - Rodriguez-Luna, Hector

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