Reduced priority MELD score for hepatocellular carcinoma does not adversely impact candidate survival awaiting liver transplantation

P. Sharma, A. M. Harper, J. L. Hernandez, T. Heffron, D. C. Mulligan, R. H. Wiesner, V. Balan

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

The liver organ allocation policy of the United Network for Organ Sharing (UNOS) is based on the model for end-stage liver disease (MELD). The policy provides additional priority for candidates with hepatocellular carcinoma (HCC) who are awaiting deceased donor liver transplantation (DDLT). However, this priority was reduced on February 27, 2003 to a MELD of 20 for stage T1 and of 24 for stage T2 HCC. The aim of this study was to determine the impact of reduced priority on HCC candidate survival while on the waiting list. The UNOS database was reviewed for all HCC candidates listed after February 27, 2002, The HCC candidates were grouped into two time periods: MELD 1 (listed between February 27, 2002, and February 26, 2003) and MELD 2 (listed between February 27, 2003 and February 26, 2004). For the two time periods, the national DDLT incidence rates for HCC patients were 1.44 versus 1.53 DDLT per person-year (p = NS) and the waiting times were similar for the two periods (138.0 ± 196.8 vs. 129.0 ± 133.8 days; p = NS). Furthermore, the 3-, 6-and 12-month candidate, patient survival and dropout rates were also similar nationally. Regional differences in rates of DDLT for HCC were observed during both MELD periods. Consequently, the reduced MELD score for stage T1 and T2 HCC candidates awaiting DDLT has not had an impact nationally either on their survival on the waiting list or on their ability to obtain a liver transplant within a reasonable time frame. However, regional variations point to the need for reform in how organs are allocated for HCC at the regional level.

Original languageEnglish (US)
Pages (from-to)1957-1962
Number of pages6
JournalAmerican Journal of Transplantation
Volume6
Issue number8
DOIs
StatePublished - Aug 2006

Fingerprint

End Stage Liver Disease
Liver Transplantation
Hepatocellular Carcinoma
Survival
Tissue Donors
Waiting Lists
Aptitude
Patient Dropouts
Liver
Survival Rate
Databases
Transplants
Incidence

Keywords

  • Deceased donor liver transplantation
  • Hepatocellular carcinoma
  • Model for end-stage liver disease

ASJC Scopus subject areas

  • Immunology

Cite this

Reduced priority MELD score for hepatocellular carcinoma does not adversely impact candidate survival awaiting liver transplantation. / Sharma, P.; Harper, A. M.; Hernandez, J. L.; Heffron, T.; Mulligan, D. C.; Wiesner, R. H.; Balan, V.

In: American Journal of Transplantation, Vol. 6, No. 8, 08.2006, p. 1957-1962.

Research output: Contribution to journalArticle

Sharma, P. ; Harper, A. M. ; Hernandez, J. L. ; Heffron, T. ; Mulligan, D. C. ; Wiesner, R. H. ; Balan, V. / Reduced priority MELD score for hepatocellular carcinoma does not adversely impact candidate survival awaiting liver transplantation. In: American Journal of Transplantation. 2006 ; Vol. 6, No. 8. pp. 1957-1962.
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abstract = "The liver organ allocation policy of the United Network for Organ Sharing (UNOS) is based on the model for end-stage liver disease (MELD). The policy provides additional priority for candidates with hepatocellular carcinoma (HCC) who are awaiting deceased donor liver transplantation (DDLT). However, this priority was reduced on February 27, 2003 to a MELD of 20 for stage T1 and of 24 for stage T2 HCC. The aim of this study was to determine the impact of reduced priority on HCC candidate survival while on the waiting list. The UNOS database was reviewed for all HCC candidates listed after February 27, 2002, The HCC candidates were grouped into two time periods: MELD 1 (listed between February 27, 2002, and February 26, 2003) and MELD 2 (listed between February 27, 2003 and February 26, 2004). For the two time periods, the national DDLT incidence rates for HCC patients were 1.44 versus 1.53 DDLT per person-year (p = NS) and the waiting times were similar for the two periods (138.0 ± 196.8 vs. 129.0 ± 133.8 days; p = NS). Furthermore, the 3-, 6-and 12-month candidate, patient survival and dropout rates were also similar nationally. Regional differences in rates of DDLT for HCC were observed during both MELD periods. Consequently, the reduced MELD score for stage T1 and T2 HCC candidates awaiting DDLT has not had an impact nationally either on their survival on the waiting list or on their ability to obtain a liver transplant within a reasonable time frame. However, regional variations point to the need for reform in how organs are allocated for HCC at the regional level.",
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