Background
The benefit of liver transplantation relative to initial degree of underlying liver
disease and time on the waiting list remains poorly defined. We sought to examine
the survival benefit attributable to liver transplantation across a wide range of
Model for End-Stage Liver Disease (MELD) scores.
Methods
The study population included patients with end-stage liver disease enlisted in Rio
Grande do Sul, Brazil, between 2001 and 2005. Survival and hazard function for enlisted
and transplanted patients were estimated using parametric and nonparametric methods.
MELD score was utilized to account for underlying liver disease.
Results
Of 1,130 eligible patients, 520 (46.0%) were transplanted, 266 (23.5%) died on the
waiting list, 141 (12.5%) were excluded from the waiting list, and 203 (18.0%) remained
enlisted and were awaiting transplantation at the time of last observation. At 1 year
after transplantation, a MELD score of 15 represented a transition point in terms
of overall survival benefit (MELD 10, 90% vs 83%; MELD 15, 81% vs 80%; MELD 20, 63%
vs 78%; MELD 25, 42% vs 74%; MELD 30, 21% vs71%; enlisted vs transplant patients,
respectively). MELD scores at which transplantation seemed to be beneficial relative
to the amount of follow-up time was MELD 23, 17, 15, and 12 at 6 months, and 1, 2,
and 5 years, respectively, from time of transplantation/enlistment.
Conclusion
Although patients with greater MELD scores enjoy a pronounced and early benefit from
transplantation, patients with lesser MELD scores do gain from transplantation, although
a greater period of time is needed to realize the survival benefit.
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References
- The evolution of liver transplantation practices.Curr Opin Organ Transplant. 2008; 13: 275-279
- Patients seeking alternatives to the long waiting list: a reality faced by transplant physicians.Prog Transplant. 2008; 18: 203-207
- Prolonged waiting times for liver transplantation in obese patients.Ann Surg. 2008; 248: 863-870
Associação Brasileira de Transplante de Órgãos. São Paulo: Associação Brasileira de Transplante de Órgãos. Registro Brasileiro de Transplantes 2008 - Ano XIV n°2 (Jan a Dez). Accessed October 1, 2009: Available from URL: http://www.abto.org.br/abtov02/portugues/populacao/rbt/anoXIV_n2/index.aspx?idCategoria=2.
- The survival benefit of liver transplantation.Am J Transplant. 2005; 5: 307-313
- When is a patient too well and when is a patient too sick for a liver transplant?.Liver Transpl. 2004; 10: S69-S73
- A correlation between the pretransplantation MELD score and mortality in the first two years after liver transplantation.Liver Transpl. 2003; 9: 117-123
- Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant.N Engl J Med. 1999; 341: 1725-1730
UNOS policy 3.2. Organ Distribution: UNOS Patient Waiting List. Richmond, VA.: United Network for Organ Sharing, revised in 03/03/2009. Accessed October 1, 2009. Available from URL: http://www.unos.org.
- Model for end-stage liver disease (MELD) and allocation of donor livers.Gastroenterology. 2003; 124: 91-96
- The new liver allocation system: moving toward evidence-based transplantation policy.Liver Transpl. 2002; 8: 851-858
- Model for the end-stage liver disease and death prediction in a cohort of Brazilian patients on the waiting list for liver transplantation.Clin Transplant. 2008; 22: 651-656
- Transient effects in the cox proportional hazards regression model.Stat Med. 1995; 14: 1553-1565
- Regression models and life tables.J Royal Stat Society Series. 1972; 34: 187-220
- MELD score as a prognostic model for listing acute liver failure patients for liver transplantation.Transplant Proc. 2006; 38: 2097-2098
- Surgery and portal hypertension.in: Child C.G. The liver and portal hypertension. Saunders, Philadelphia1964: 50-64
- Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis.N Engl J Med. 1996; 334: 693-699
- Liver transplantation in the era of model for end-stage liver disease.Liver Int. 2004; 24: 1-8
- Nonparametric estimation from incomplete observations.Am Stat Assoc J. 1958; 53: 457-480
- Parametric survival analysis and taxonomy of hazard functions for the generalized gamma distribution.Stat Med. 2007; 26: 4352-4374
- Multiple imputation: a primer.Stat Methods Med Res. 1999; 8: 3-15
- Multiple imputation for nonresponse in surveys.Wiley-Interscience, Hoboken, NJ2004
- Characteristics associated with liver graft failure: the concept of a donor risk index.Am J Transplant. 2006; 6: 783-790
- The epidemiology of hepatitis C infection in the United States.J Gastroenterol. 2007; 42: 513-521
- The survival benefit of deceased donor liver transplantation as a function of candidate disease severity and donor quality.Am J Transplant. 2008; 8: 419-425
- MELD scores of liver transplant recipients according to size of waiting list: impact of organ allocation and patient outcomes.JAMA. 2004; 291: 1871-1874
- The sickest first? Disparities with model for end-stage liver disease-based organ allocation: one region's experience.Liver Transpl. 2003; 9: 1211-1215
- Model for End-Stage Liver Disease (MELD) score and organ allocation from cadaveric donors for 198 liver transplantation procedures performed in a single center.Transplant Proc. 2008; 40: 1903-1905
- Flexible parametric proportional-hazards and proportional-odds models for censored survival data with application to prognostic modelling and estimation.Stat Med. 2002; 15: 2175-2197
- Long-term survival with non-proportional hazards: results from the Dutch Gastric Cancer Trial.Stat Med. 2005; 24: 2807-2821
Article info
Publication history
Published online: December 04, 2009
Accepted:
October 2,
2009
Footnotes
Dr Pawlik is supported by Grant Number 1KL2RR025006-01 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Dr Gleisner has been supported by a UICC American Cancer Society Beginning Investigators Fellowship funded by the American Cancer Society and by a grant from CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nivel Superior). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH.
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© 2010 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
