Proportion of MELD Exceptions Up From 2002 to 2010

Since April 2005, HCC and other exceptions associated with decreased risk of wait-list mortality

MONDAY, Oct. 31 (HealthDay News) -- The proportion of liver transplant candidates who are model for end-stage liver disease (MELD) exceptions increased from 2002 to 2010, and since April 2005, exceptions have been associated with a reduced risk of wait-list mortality, according to a study published in the November issue of the American Journal of Transplantation.

Allan B. Massie, Ph.D., from the Johns Hopkins University School of Medicine in Baltimore, and colleagues investigated longitudinal MELD score, exception, and outcome in 88,981 adult liver candidates from 2002 to 2010. They tested the hypothesis that organ procurement organizations (OPOs) differ in exception practices, investigated the use of exceptions over time, and assessed whether exception patients have an advantage relative to other patients.

The investigators found that the proportion of patients receiving a hepatocellular carcinoma (HCC) exception at the OPO-level and regional levels was 0 to 21.4 percent, and 11.9 to 18.8 percent, respectively. The proportion of patients receiving exceptions for other conditions was 0 to 13.1 percent and 3.7 to 9.5 percent at the OPO- and regional levels. There was a significant increase in HCC and other exceptions over time. Since April 2005, HCC and other exceptions correlated with a significantly reduced risk of wait-list mortality compared to nonexception patients who had an equivalent priority listing.

"In this eight-year national study of patients awaiting liver transplantation, those who received a MELD exception dropped out at lower rates, and were transplanted at higher rates, than those with equivalent calculated MELD," the authors write.

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