The Precise Relationship Between Model for End‐Stage Liver Disease and Survival Without a Liver Transplant

Background and Aims Scores from the Model for End‐Stage Liver Disease (MELD), which are used to prioritize candidates for deceased donor livers, are widely acknowledged to be negatively correlated with the 90‐day survival rate without a liver transplant. However, inconsistent and outdated estimates...

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Veröffentlicht in:Hepatology (Baltimore, Md.) Md.), 2021-08, Vol.74 (2), p.950-960
Hauptverfasser: VanDerwerken, Douglas N., Wood, Nicholas L., Segev, Dorry L., Gentry, Sommer E.
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container_issue 2
container_start_page 950
container_title Hepatology (Baltimore, Md.)
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creator VanDerwerken, Douglas N.
Wood, Nicholas L.
Segev, Dorry L.
Gentry, Sommer E.
description Background and Aims Scores from the Model for End‐Stage Liver Disease (MELD), which are used to prioritize candidates for deceased donor livers, are widely acknowledged to be negatively correlated with the 90‐day survival rate without a liver transplant. However, inconsistent and outdated estimates of survival probabilities by MELD preclude useful applications of the MELD score. Approach and Results Using data from all prevalent liver waitlist candidates from 2016 to 2019, we estimated 3‐day, 7‐day, 14‐day, 30‐day, and 90‐day without‐transplant survival probabilities (with confidence intervals) for each MELD score and status 1A. We used an adjusted Kaplan‐Meier model to avoid unrealistic assumptions and multiple observations per person instead of just the observation at listing. We found that 90‐day without‐transplant survival has improved over the last decade, with survival rates increasing >10% (in absolute terms) for some MELD scores. We demonstrated that MELD correctly prioritizes candidates in terms of without‐transplant survival probability but that status 1A candidates’ short‐term without‐transplant survival is higher than that of MELD 40 candidates and lower than that of MELD 39 candidates. Our primary result is the updated survival functions themselves. Conclusions We calculated without‐transplant survival probabilities for each MELD score (and status 1A). The survival function is an invaluable tool for many applications in liver transplantation: awarding of exception points, calculating the relative demand for deceased donor livers in different geographic areas, calibrating the pediatric end‐stage liver disease score, and deciding whether to accept an offered liver.
doi_str_mv 10.1002/hep.31781
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However, inconsistent and outdated estimates of survival probabilities by MELD preclude useful applications of the MELD score. Approach and Results Using data from all prevalent liver waitlist candidates from 2016 to 2019, we estimated 3‐day, 7‐day, 14‐day, 30‐day, and 90‐day without‐transplant survival probabilities (with confidence intervals) for each MELD score and status 1A. We used an adjusted Kaplan‐Meier model to avoid unrealistic assumptions and multiple observations per person instead of just the observation at listing. We found that 90‐day without‐transplant survival has improved over the last decade, with survival rates increasing &gt;10% (in absolute terms) for some MELD scores. We demonstrated that MELD correctly prioritizes candidates in terms of without‐transplant survival probability but that status 1A candidates’ short‐term without‐transplant survival is higher than that of MELD 40 candidates and lower than that of MELD 39 candidates. Our primary result is the updated survival functions themselves. Conclusions We calculated without‐transplant survival probabilities for each MELD score (and status 1A). The survival function is an invaluable tool for many applications in liver transplantation: awarding of exception points, calculating the relative demand for deceased donor livers in different geographic areas, calibrating the pediatric end‐stage liver disease score, and deciding whether to accept an offered liver.</description><identifier>ISSN: 0270-9139</identifier><identifier>EISSN: 1527-3350</identifier><identifier>DOI: 10.1002/hep.31781</identifier><identifier>PMID: 33655565</identifier><language>eng</language><publisher>HOBOKEN: Wiley</publisher><subject>Adult ; Cohort Studies ; End Stage Liver Disease - diagnosis ; End Stage Liver Disease - mortality ; End Stage Liver Disease - surgery ; Female ; Gastroenterology &amp; Hepatology ; Hepatology ; Humans ; Life Sciences &amp; Biomedicine ; Liver diseases ; Liver transplantation ; Liver Transplantation - standards ; Liver transplants ; Male ; Middle Aged ; Pediatrics ; Risk Assessment - methods ; Risk Assessment - statistics &amp; numerical data ; Science &amp; Technology ; Severity of Illness Index ; Survival ; Survival Rate ; Waiting Lists - mortality</subject><ispartof>Hepatology (Baltimore, Md.), 2021-08, Vol.74 (2), p.950-960</ispartof><rights>2021 by the American Association for the Study of Liver Diseases. This article has been contributed to by US Government employees and their work is in the public domain in the USA</rights><rights>2021 by the American Association for the Study of Liver Diseases. 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However, inconsistent and outdated estimates of survival probabilities by MELD preclude useful applications of the MELD score. Approach and Results Using data from all prevalent liver waitlist candidates from 2016 to 2019, we estimated 3‐day, 7‐day, 14‐day, 30‐day, and 90‐day without‐transplant survival probabilities (with confidence intervals) for each MELD score and status 1A. We used an adjusted Kaplan‐Meier model to avoid unrealistic assumptions and multiple observations per person instead of just the observation at listing. We found that 90‐day without‐transplant survival has improved over the last decade, with survival rates increasing &gt;10% (in absolute terms) for some MELD scores. We demonstrated that MELD correctly prioritizes candidates in terms of without‐transplant survival probability but that status 1A candidates’ short‐term without‐transplant survival is higher than that of MELD 40 candidates and lower than that of MELD 39 candidates. Our primary result is the updated survival functions themselves. Conclusions We calculated without‐transplant survival probabilities for each MELD score (and status 1A). 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However, inconsistent and outdated estimates of survival probabilities by MELD preclude useful applications of the MELD score. Approach and Results Using data from all prevalent liver waitlist candidates from 2016 to 2019, we estimated 3‐day, 7‐day, 14‐day, 30‐day, and 90‐day without‐transplant survival probabilities (with confidence intervals) for each MELD score and status 1A. We used an adjusted Kaplan‐Meier model to avoid unrealistic assumptions and multiple observations per person instead of just the observation at listing. We found that 90‐day without‐transplant survival has improved over the last decade, with survival rates increasing &gt;10% (in absolute terms) for some MELD scores. We demonstrated that MELD correctly prioritizes candidates in terms of without‐transplant survival probability but that status 1A candidates’ short‐term without‐transplant survival is higher than that of MELD 40 candidates and lower than that of MELD 39 candidates. Our primary result is the updated survival functions themselves. Conclusions We calculated without‐transplant survival probabilities for each MELD score (and status 1A). The survival function is an invaluable tool for many applications in liver transplantation: awarding of exception points, calculating the relative demand for deceased donor livers in different geographic areas, calibrating the pediatric end‐stage liver disease score, and deciding whether to accept an offered liver.</abstract><cop>HOBOKEN</cop><pub>Wiley</pub><pmid>33655565</pmid><doi>10.1002/hep.31781</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-4530-8917</orcidid><orcidid>https://orcid.org/0000-0002-1761-4960</orcidid></addata></record>
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subjects Adult
Cohort Studies
End Stage Liver Disease - diagnosis
End Stage Liver Disease - mortality
End Stage Liver Disease - surgery
Female
Gastroenterology & Hepatology
Hepatology
Humans
Life Sciences & Biomedicine
Liver diseases
Liver transplantation
Liver Transplantation - standards
Liver transplants
Male
Middle Aged
Pediatrics
Risk Assessment - methods
Risk Assessment - statistics & numerical data
Science & Technology
Severity of Illness Index
Survival
Survival Rate
Waiting Lists - mortality
title The Precise Relationship Between Model for End‐Stage Liver Disease and Survival Without a Liver Transplant
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