Use of rapid Model for End-Stage Liver Disease (MELD) increases for liver transplant registrant prioritization after MELD-Na and Share 35, an evaluation using data from the United Network for Organ Sharing


Autoři: Guy N. Brock aff001;  Kenneth Washburn aff002;  Michael R. Marvin aff004
Působiště autorů: Department of Biomedical Informatics and Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH, United States of America aff001;  Department of Surgery, Division of Transplantation Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, United States of America aff002;  Center for Surgical Health Assessment, Research and Policy (SHARP), Wexner Medical Center, The Ohio State University, Columbus, OH, United States of America aff003;  Department of Transplantation and Liver Surgery, Geisinger Medical Center, Danville, PA, United States of America aff004
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223053

Souhrn

The Model for End-Stage Liver Disease (MELD) score has been successfully used to prioritize patients on the United States liver transplant waiting list since its adoption in 2002. The United Network for Organ Sharing (UNOS)/Organ Procurement Transplantation Network (OPTN) allocation policy has evolved over the years, and notable recent changes include Share 35, inclusion of serum sodium in the MELD score, and a ‘delay and cap’ policy for hepatocellular carcinoma (HCC) patients. We explored the potential of a registrant’s change in 30-day MELD scores (ΔMELD30) to improve allocation both before and after these policy changes. Current MELD and ΔMELD30 were evaluated using cause-specific hazards models for waitlist dropout based on US liver transplant registrants added to the waitlist between 06/30/2003 and 6/30/2013. Two composite scores were constructed and then evaluated on UNOS data spanning the current policy era (01/02/2016 to 09/07/2018). Predictive accuracy was evaluated using the C-index for model discrimination and by comparing observed and predicted waitlist dropout probabilities for model calibration. After the change to MELD-Na, increased dropout associated with ΔMELD30 jumps is no longer evident at MELD scores below 30. However, the adoption of Share 35 has potentially resulted in discrepancies in waitlist dropout for patients with sharp MELD increases at higher MELD scores. Use of the ΔMELD30 to add additional points or serve as a potential tiebreaker for patients with rapid deterioration may extend the benefit of Share 35 to better include those in most critical need.

Klíčová slova:

Alcoholics – Cirrhosis – Coronary heart disease – Diabetes mellitus – Hepatocellular carcinoma – Liver diseases – Liver transplantation – Primary biliary cirrhosis


Zdroje

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Článek vyšel v časopise

PLOS One


2019 Číslo 10

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