MELD as a metric for survival benefit of liver transplantation
Currently, there is debate among the liver transplant community regarding the most appropriate mechanism for organ allocation: urgency‐based (MELD) versus utility‐based (survival benefit). We hypothesize that MELD and survival benefit are closely associated, and therefore, our current MELD‐based all...
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| Veröffentlicht in: | American journal of transplantation 2018-05, Vol.18 (5), p.1231-1237 |
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| container_title | American journal of transplantation |
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| creator | Luo, Xun Leanza, Joseph Massie, Allan B. Garonzik‐Wang, Jacqueline M. Haugen, Christine E. Gentry, Sommer E. Ottmann, Shane E. Segev, Dorry L. |
| description | Currently, there is debate among the liver transplant community regarding the most appropriate mechanism for organ allocation: urgency‐based (MELD) versus utility‐based (survival benefit). We hypothesize that MELD and survival benefit are closely associated, and therefore, our current MELD‐based allocation already reflects utility‐based allocation. We used generalized gamma parametric models to quantify survival benefit of LT across MELD categories among 74 196 adult liver‐only active candidates between 2006 and 2016 in the United States. We calculated time ratios (TR) of relative life expectancy with transplantation versus without and calculated expected life years gained after LT. LT extended life expectancy (TR > 1) for patients with MELD > 10. The highest MELD was associated with the longest relative life expectancy (TR = 1.051.201.37 for MELD 11‐15, 2.292.492.70 for MELD 16‐20, 5.305.726.16 for MELD 21‐25, 15.1216.3517.67 for MELD 26‐30; 39.2643.2147.55 for MELD 31‐34; 120.04128.25137.02 for MELD 35‐40). As a result, candidates with the highest MELD gained the most life years after LT: 0.2, 1.5, 3.5, 5.8, 6.9, 7.2 years for MELD 11‐15, 16‐20, 21‐25, 26‐30, 31‐34, 35‐40, respectively. Therefore, prioritizing candidates by MELD remains a simple, effective strategy for prioritizing candidates with a higher transplant survival benefit over those with lower survival benefit.
The Model for End‐Stage Liver Disease (MELD) functions not only as a predictor of waitlist mortality, but also as a measure of survival benefit after liver transplantation, and therefore our current allocation policy considers both equity and utility. |
| doi_str_mv | 10.1111/ajt.14660 |
| format | Article |
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The Model for End‐Stage Liver Disease (MELD) functions not only as a predictor of waitlist mortality, but also as a measure of survival benefit after liver transplantation, and therefore our current allocation policy considers both equity and utility.</description><identifier>ISSN: 1600-6135</identifier><identifier>EISSN: 1600-6143</identifier><identifier>DOI: 10.1111/ajt.14660</identifier><identifier>PMID: 29316310</identifier><language>eng</language><publisher>United States: Elsevier Limited</publisher><subject>classification systems: Model for End‐stage Liver Disease (MELD) ; clinical research/practice ; End Stage Liver Disease - mortality ; End Stage Liver Disease - pathology ; End Stage Liver Disease - surgery ; Female ; Follow-Up Studies ; health services and outcomes research ; Humans ; Life expectancy ; Life span ; liver disease ; Liver diseases ; Liver transplantation ; Liver Transplantation - mortality ; liver transplantation/hepatology ; Liver transplants ; Male ; Middle Aged ; organ allocation ; organ procurement and allocation ; organ transplantation in general ; Patient Selection ; patient survival ; Prognosis ; registry/registry analysis ; Severity of Illness Index ; Survival ; Survival Rate ; Time Factors ; Time-to-Treatment ; Tissue and Organ Procurement - statistics & numerical data ; Tissue Donors - supply & distribution ; Transplants & implants ; Waiting Lists - mortality</subject><ispartof>American journal of transplantation, 2018-05, Vol.18 (5), p.1231-1237</ispartof><rights>2018 The American Society of Transplantation and the American Society of Transplant Surgeons</rights><rights>2018 The American Society of Transplantation and the American Society of Transplant Surgeons.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4430-58044837a0af4c68f7c4e5cb3c19805426ee4b8d48fa20e47b4bd2cf7f9eebec3</citedby><cites>FETCH-LOGICAL-c4430-58044837a0af4c68f7c4e5cb3c19805426ee4b8d48fa20e47b4bd2cf7f9eebec3</cites><orcidid>0000-0001-5884-2604 ; 0000-0003-4530-8917</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fajt.14660$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fajt.14660$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29316310$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Luo, Xun</creatorcontrib><creatorcontrib>Leanza, Joseph</creatorcontrib><creatorcontrib>Massie, Allan B.</creatorcontrib><creatorcontrib>Garonzik‐Wang, Jacqueline M.</creatorcontrib><creatorcontrib>Haugen, Christine E.</creatorcontrib><creatorcontrib>Gentry, Sommer E.</creatorcontrib><creatorcontrib>Ottmann, Shane E.</creatorcontrib><creatorcontrib>Segev, Dorry L.</creatorcontrib><title>MELD as a metric for survival benefit of liver transplantation</title><title>American journal of transplantation</title><addtitle>Am J Transplant</addtitle><description>Currently, there is debate among the liver transplant community regarding the most appropriate mechanism for organ allocation: urgency‐based (MELD) versus utility‐based (survival benefit). We hypothesize that MELD and survival benefit are closely associated, and therefore, our current MELD‐based allocation already reflects utility‐based allocation. We used generalized gamma parametric models to quantify survival benefit of LT across MELD categories among 74 196 adult liver‐only active candidates between 2006 and 2016 in the United States. We calculated time ratios (TR) of relative life expectancy with transplantation versus without and calculated expected life years gained after LT. LT extended life expectancy (TR > 1) for patients with MELD > 10. The highest MELD was associated with the longest relative life expectancy (TR = 1.051.201.37 for MELD 11‐15, 2.292.492.70 for MELD 16‐20, 5.305.726.16 for MELD 21‐25, 15.1216.3517.67 for MELD 26‐30; 39.2643.2147.55 for MELD 31‐34; 120.04128.25137.02 for MELD 35‐40). As a result, candidates with the highest MELD gained the most life years after LT: 0.2, 1.5, 3.5, 5.8, 6.9, 7.2 years for MELD 11‐15, 16‐20, 21‐25, 26‐30, 31‐34, 35‐40, respectively. Therefore, prioritizing candidates by MELD remains a simple, effective strategy for prioritizing candidates with a higher transplant survival benefit over those with lower survival benefit.
The Model for End‐Stage Liver Disease (MELD) functions not only as a predictor of waitlist mortality, but also as a measure of survival benefit after liver transplantation, and therefore our current allocation policy considers both equity and utility.</description><subject>classification systems: Model for End‐stage Liver Disease (MELD)</subject><subject>clinical research/practice</subject><subject>End Stage Liver Disease - mortality</subject><subject>End Stage Liver Disease - pathology</subject><subject>End Stage Liver Disease - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>health services and outcomes research</subject><subject>Humans</subject><subject>Life expectancy</subject><subject>Life span</subject><subject>liver disease</subject><subject>Liver diseases</subject><subject>Liver transplantation</subject><subject>Liver Transplantation - mortality</subject><subject>liver transplantation/hepatology</subject><subject>Liver transplants</subject><subject>Male</subject><subject>Middle Aged</subject><subject>organ allocation</subject><subject>organ procurement and allocation</subject><subject>organ transplantation in general</subject><subject>Patient Selection</subject><subject>patient survival</subject><subject>Prognosis</subject><subject>registry/registry analysis</subject><subject>Severity of Illness Index</subject><subject>Survival</subject><subject>Survival Rate</subject><subject>Time Factors</subject><subject>Time-to-Treatment</subject><subject>Tissue and Organ Procurement - statistics & numerical data</subject><subject>Tissue Donors - supply & distribution</subject><subject>Transplants & implants</subject><subject>Waiting Lists - mortality</subject><issn>1600-6135</issn><issn>1600-6143</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kctKAzEUhoMo3he-gATc6KKa22QmG6F4l4obXYdMeqIp00lNZiq-vdFqUcGzyYF8fPyHH6E9So5pnhMz6Y6pkJKsoE0qCRlIKvjqcufFBtpKaUIILVnF1tEGU5xKTskmOr27GJ1jk7DBU-iit9iFiFMf535uGlxDC853ODjc-DlE3EXTpllj2s50PrQ7aM2ZJsHu17uNHi8vHs6uB6P7q5uz4WhgheBkUFREiIqXhhgnrKxcaQUUtuaWqooUgkkAUVdjUTnDCIiyFvWYWVc6BVCD5dvodOGd9fUUxhbaHKTRs-inJr7pYLz-_dP6Z_0U5lpSKgvOsuDwSxDDSw-p01OfLDT5Egh90jmHKsqCKp7Rgz_oJPSxzedpRlgpFVNKZepoQdkYUorglmEo0R-t6NyK_mwls_s_0y_J7xoycLIAXn0Db_-b9PD2YaF8B2QHlnc</recordid><startdate>201805</startdate><enddate>201805</enddate><creator>Luo, Xun</creator><creator>Leanza, Joseph</creator><creator>Massie, Allan B.</creator><creator>Garonzik‐Wang, Jacqueline M.</creator><creator>Haugen, Christine E.</creator><creator>Gentry, Sommer E.</creator><creator>Ottmann, Shane E.</creator><creator>Segev, Dorry L.</creator><general>Elsevier Limited</general><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>7QP</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5884-2604</orcidid><orcidid>https://orcid.org/0000-0003-4530-8917</orcidid></search><sort><creationdate>201805</creationdate><title>MELD as a metric for survival benefit of liver transplantation</title><author>Luo, Xun ; Leanza, Joseph ; Massie, Allan B. ; Garonzik‐Wang, Jacqueline M. ; Haugen, Christine E. ; Gentry, Sommer E. ; Ottmann, Shane E. ; Segev, Dorry L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4430-58044837a0af4c68f7c4e5cb3c19805426ee4b8d48fa20e47b4bd2cf7f9eebec3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>classification systems: Model for End‐stage Liver Disease (MELD)</topic><topic>clinical research/practice</topic><topic>End Stage Liver Disease - mortality</topic><topic>End Stage Liver Disease - pathology</topic><topic>End Stage Liver Disease - surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>health services and outcomes research</topic><topic>Humans</topic><topic>Life expectancy</topic><topic>Life span</topic><topic>liver disease</topic><topic>Liver diseases</topic><topic>Liver transplantation</topic><topic>Liver Transplantation - mortality</topic><topic>liver transplantation/hepatology</topic><topic>Liver transplants</topic><topic>Male</topic><topic>Middle Aged</topic><topic>organ allocation</topic><topic>organ procurement and allocation</topic><topic>organ transplantation in general</topic><topic>Patient Selection</topic><topic>patient survival</topic><topic>Prognosis</topic><topic>registry/registry analysis</topic><topic>Severity of Illness Index</topic><topic>Survival</topic><topic>Survival Rate</topic><topic>Time Factors</topic><topic>Time-to-Treatment</topic><topic>Tissue and Organ Procurement - statistics & numerical data</topic><topic>Tissue Donors - supply & distribution</topic><topic>Transplants & implants</topic><topic>Waiting Lists - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Luo, Xun</creatorcontrib><creatorcontrib>Leanza, Joseph</creatorcontrib><creatorcontrib>Massie, Allan B.</creatorcontrib><creatorcontrib>Garonzik‐Wang, Jacqueline M.</creatorcontrib><creatorcontrib>Haugen, Christine E.</creatorcontrib><creatorcontrib>Gentry, Sommer E.</creatorcontrib><creatorcontrib>Ottmann, Shane E.</creatorcontrib><creatorcontrib>Segev, Dorry L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology 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><collection>PubMed Central (Full Participant titles)</collection><jtitle>American journal of transplantation</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Luo, Xun</au><au>Leanza, Joseph</au><au>Massie, Allan B.</au><au>Garonzik‐Wang, Jacqueline M.</au><au>Haugen, Christine E.</au><au>Gentry, Sommer E.</au><au>Ottmann, Shane E.</au><au>Segev, Dorry L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>MELD as a metric for survival benefit of liver transplantation</atitle><jtitle>American journal of transplantation</jtitle><addtitle>Am J Transplant</addtitle><date>2018-05</date><risdate>2018</risdate><volume>18</volume><issue>5</issue><spage>1231</spage><epage>1237</epage><pages>1231-1237</pages><issn>1600-6135</issn><eissn>1600-6143</eissn><abstract>Currently, there is debate among the liver transplant community regarding the most appropriate mechanism for organ allocation: urgency‐based (MELD) versus utility‐based (survival benefit). We hypothesize that MELD and survival benefit are closely associated, and therefore, our current MELD‐based allocation already reflects utility‐based allocation. We used generalized gamma parametric models to quantify survival benefit of LT across MELD categories among 74 196 adult liver‐only active candidates between 2006 and 2016 in the United States. We calculated time ratios (TR) of relative life expectancy with transplantation versus without and calculated expected life years gained after LT. LT extended life expectancy (TR > 1) for patients with MELD > 10. The highest MELD was associated with the longest relative life expectancy (TR = 1.051.201.37 for MELD 11‐15, 2.292.492.70 for MELD 16‐20, 5.305.726.16 for MELD 21‐25, 15.1216.3517.67 for MELD 26‐30; 39.2643.2147.55 for MELD 31‐34; 120.04128.25137.02 for MELD 35‐40). As a result, candidates with the highest MELD gained the most life years after LT: 0.2, 1.5, 3.5, 5.8, 6.9, 7.2 years for MELD 11‐15, 16‐20, 21‐25, 26‐30, 31‐34, 35‐40, respectively. Therefore, prioritizing candidates by MELD remains a simple, effective strategy for prioritizing candidates with a higher transplant survival benefit over those with lower survival benefit.
The Model for End‐Stage Liver Disease (MELD) functions not only as a predictor of waitlist mortality, but also as a measure of survival benefit after liver transplantation, and therefore our current allocation policy considers both equity and utility.</abstract><cop>United States</cop><pub>Elsevier Limited</pub><pmid>29316310</pmid><doi>10.1111/ajt.14660</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0001-5884-2604</orcidid><orcidid>https://orcid.org/0000-0003-4530-8917</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | classification systems: Model for End‐stage Liver Disease (MELD) clinical research/practice End Stage Liver Disease - mortality End Stage Liver Disease - pathology End Stage Liver Disease - surgery Female Follow-Up Studies health services and outcomes research Humans Life expectancy Life span liver disease Liver diseases Liver transplantation Liver Transplantation - mortality liver transplantation/hepatology Liver transplants Male Middle Aged organ allocation organ procurement and allocation organ transplantation in general Patient Selection patient survival Prognosis registry/registry analysis Severity of Illness Index Survival Survival Rate Time Factors Time-to-Treatment Tissue and Organ Procurement - statistics & numerical data Tissue Donors - supply & distribution Transplants & implants Waiting Lists - mortality |
| title | MELD as a metric for survival benefit of liver transplantation |
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