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 However, inconsistent and outdated estimates...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 |
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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 However, inconsistent and outdated estimates of survival probabilities by MELD preclude useful applications of the MELD score.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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fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_2564443518</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2564443518</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3531-e457a8aa46f1b6474b504a8f10f85d5843d8503a25019fc2a8a01514868df1603</originalsourceid><addsrcrecordid>eNqNkc1uEzEURi0EoqGw4AWQJTYgNK3_x7OEEChSEBUNYmk5M9fE1cQe7JlU3fEIPCNPgtuELpCQWF0vznfvJx-EnlJyQglhpxsYTjitNb2HZlSyuuJckvtoRlhNqoby5gg9yvmSENIIph-iI86VlFLJGepXG8DnCVqfAX-G3o4-hrzxA34D4xVAwB9jBz12MeFF6H79-Hkx2m-Al34HCb8tKVuCNnT4Yko7v7M9_urHTZxGbA_QKtmQh96G8TF64Gyf4clhHqMv7xar-Vm1_PT-w_z1smq55LQCIWurrRXK0bUStVhLIqx2lDgtO6kF77Qk3DJJaONaVlhCJRVa6c5RRfgxerHfO6T4fYI8mq3PLfSlA8QpGyYaxQSjhBb0-V_oZZxSKO0Mk0oIwSXVhXq5p9oUc07gzJD81qZrQ4m5UWCKAnOroLDPDhun9Ra6O_LPnxfg1R64gnV0ufUQWrjDiiSltSiiyovdnNb_T8_9eCtwHqcwlujpIep7uP53ZXO2ON93_w1aSK_G</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2564443518</pqid></control><display><type>article</type><title>The Precise Relationship Between Model for End‐Stage Liver Disease and Survival Without a Liver Transplant</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><source>Web of Science - Science Citation Index Expanded - 2021<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" /></source><source>EZB-FREE-00999 freely available EZB journals</source><creator>VanDerwerken, Douglas N. ; Wood, Nicholas L. ; Segev, Dorry L. ; Gentry, Sommer E.</creator><creatorcontrib>VanDerwerken, Douglas N. ; Wood, Nicholas L. ; Segev, Dorry L. ; Gentry, Sommer E.</creatorcontrib><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.</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 & 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</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. 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.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>10</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000688494200028</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c3531-e457a8aa46f1b6474b504a8f10f85d5843d8503a25019fc2a8a01514868df1603</citedby><cites>FETCH-LOGICAL-c3531-e457a8aa46f1b6474b504a8f10f85d5843d8503a25019fc2a8a01514868df1603</cites><orcidid>0000-0003-4530-8917 ; 0000-0002-1761-4960</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fhep.31781$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fhep.31781$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,781,785,1418,27929,27930,39263,45579,45580</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33655565$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>VanDerwerken, Douglas N.</creatorcontrib><creatorcontrib>Wood, Nicholas L.</creatorcontrib><creatorcontrib>Segev, Dorry L.</creatorcontrib><creatorcontrib>Gentry, Sommer E.</creatorcontrib><title>The Precise Relationship Between Model for End‐Stage Liver Disease and Survival Without a Liver Transplant</title><title>Hepatology (Baltimore, Md.)</title><addtitle>HEPATOLOGY</addtitle><addtitle>Hepatology</addtitle><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.</description><subject>Adult</subject><subject>Cohort Studies</subject><subject>End Stage Liver Disease - diagnosis</subject><subject>End Stage Liver Disease - mortality</subject><subject>End Stage Liver Disease - surgery</subject><subject>Female</subject><subject>Gastroenterology & Hepatology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Life Sciences & Biomedicine</subject><subject>Liver diseases</subject><subject>Liver transplantation</subject><subject>Liver Transplantation - standards</subject><subject>Liver transplants</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Pediatrics</subject><subject>Risk Assessment - methods</subject><subject>Risk Assessment - statistics & numerical data</subject><subject>Science & Technology</subject><subject>Severity of Illness Index</subject><subject>Survival</subject><subject>Survival Rate</subject><subject>Waiting Lists - mortality</subject><issn>0270-9139</issn><issn>1527-3350</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>HGBXW</sourceid><sourceid>EIF</sourceid><recordid>eNqNkc1uEzEURi0EoqGw4AWQJTYgNK3_x7OEEChSEBUNYmk5M9fE1cQe7JlU3fEIPCNPgtuELpCQWF0vznfvJx-EnlJyQglhpxsYTjitNb2HZlSyuuJckvtoRlhNqoby5gg9yvmSENIIph-iI86VlFLJGepXG8DnCVqfAX-G3o4-hrzxA34D4xVAwB9jBz12MeFF6H79-Hkx2m-Al34HCb8tKVuCNnT4Yko7v7M9_urHTZxGbA_QKtmQh96G8TF64Gyf4clhHqMv7xar-Vm1_PT-w_z1smq55LQCIWurrRXK0bUStVhLIqx2lDgtO6kF77Qk3DJJaONaVlhCJRVa6c5RRfgxerHfO6T4fYI8mq3PLfSlA8QpGyYaxQSjhBb0-V_oZZxSKO0Mk0oIwSXVhXq5p9oUc07gzJD81qZrQ4m5UWCKAnOroLDPDhun9Ra6O_LPnxfg1R64gnV0ufUQWrjDiiSltSiiyovdnNb_T8_9eCtwHqcwlujpIep7uP53ZXO2ON93_w1aSK_G</recordid><startdate>202108</startdate><enddate>202108</enddate><creator>VanDerwerken, Douglas N.</creator><creator>Wood, Nicholas L.</creator><creator>Segev, Dorry L.</creator><creator>Gentry, Sommer E.</creator><general>Wiley</general><general>Wiley Subscription Services, Inc</general><scope>BLEPL</scope><scope>DTL</scope><scope>HGBXW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7TM</scope><scope>7TO</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-4530-8917</orcidid><orcidid>https://orcid.org/0000-0002-1761-4960</orcidid></search><sort><creationdate>202108</creationdate><title>The Precise Relationship Between Model for End‐Stage Liver Disease and Survival Without a Liver Transplant</title><author>VanDerwerken, Douglas N. ; Wood, Nicholas L. ; Segev, Dorry L. ; Gentry, Sommer E.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3531-e457a8aa46f1b6474b504a8f10f85d5843d8503a25019fc2a8a01514868df1603</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Cohort Studies</topic><topic>End Stage Liver Disease - diagnosis</topic><topic>End Stage Liver Disease - mortality</topic><topic>End Stage Liver Disease - surgery</topic><topic>Female</topic><topic>Gastroenterology & Hepatology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Life Sciences & Biomedicine</topic><topic>Liver diseases</topic><topic>Liver transplantation</topic><topic>Liver Transplantation - standards</topic><topic>Liver transplants</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Pediatrics</topic><topic>Risk Assessment - methods</topic><topic>Risk Assessment - statistics & numerical data</topic><topic>Science & Technology</topic><topic>Severity of Illness Index</topic><topic>Survival</topic><topic>Survival Rate</topic><topic>Waiting Lists - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>VanDerwerken, Douglas N.</creatorcontrib><creatorcontrib>Wood, Nicholas L.</creatorcontrib><creatorcontrib>Segev, Dorry L.</creatorcontrib><creatorcontrib>Gentry, Sommer E.</creatorcontrib><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Web of Science - Science Citation Index Expanded - 2021</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Hepatology (Baltimore, Md.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>VanDerwerken, Douglas N.</au><au>Wood, Nicholas L.</au><au>Segev, Dorry L.</au><au>Gentry, Sommer E.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The Precise Relationship Between Model for End‐Stage Liver Disease and Survival Without a Liver Transplant</atitle><jtitle>Hepatology (Baltimore, Md.)</jtitle><stitle>HEPATOLOGY</stitle><addtitle>Hepatology</addtitle><date>2021-08</date><risdate>2021</risdate><volume>74</volume><issue>2</issue><spage>950</spage><epage>960</epage><pages>950-960</pages><issn>0270-9139</issn><eissn>1527-3350</eissn><abstract>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.</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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