Non-HCC patients have higher mortality risk; suggests need for revaluation of organ allocation
FRIDAY, March 30 (HealthDay News) -- Liver transplantation candidates with hepatocellular carcinoma (HCC) have significantly lower 90-day odds of waitlist removal due to clinical deterioration or death compared to non-HCC candidates with similar Model for End-Stage Liver Disease (MELD) scores, according to a study published in the April issue of Liver Transplantation.
David Goldberg, M.D., of the University of Pennsylvania in Philadelphia, and colleagues utilized data from the United Network for Organ Sharing (from January 2005 through May 2009) to compare 90-day waitlist outcomes for 6,246 candidates with HCC and 2,564 non-HCC candidates with similar MELD scores.
Within 90 days of listing, the researchers found that 4.2 percent of HCC candidates with 22 MELD exception points were removed from the waitlist for death or clinical deterioration, compared with 11.0 percent of non-HCC candidates with MELD scores of 21 to 23. Of those with 24 to 26 MELD exception points after three to six months of wait time, 4.6 percent of HCC candidates and 17.3 percent of non-HCC candidates were removed from the waitlist. Of those with 27 to 29 MELD exception points after six to nine months of wait time, 3.0 percent of HCC candidates and 23.6 percent of non-HCC candidates were removed. For HCC candidates, waitlist removal due to mortality or deterioration remained relatively unchanged over time, but the risk was significantly increased for non-HCC candidates.
"[The study] adds strength to the argument that the 'sickest first' policy may not be well served by the current allocation methods for HCC under the MELD system," writes the author of an accompanying editorial. "The allocation system should be managed as a whole, rather than as isolated pieces, to ensure patients on the waitlist are prioritized based on the desire to minimize waitlist mortality."
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