Should liver transplantation in patients with model for end-stage liver disease scores ≤ 14 be avoided? A decision analysis approach

✍ Scribed by James D. Perkins; Jeffrey B. Halldorson; Ramasamy Bakthavatsalam; Oren K. Fix; Robert L. Carithers Jr; Jorge D. Reyes

• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 555 KB
• Volume: 15
• Category: Article
• ISSN: 1527-6465
• DOI: 10.1002/lt.21703

✦ Synopsis

Studies have shown that liver transplantation offers no survival benefits to patients with Model for End-Stage Liver Disease (MELD) scores Յ 14 in comparison with remaining on the waitlist. The consensus of a 2003 transplant community national conference was that a minimum MELD score should be required for placement on the liver waitlist, but no minimum listing national policy was enacted at that time. We developed a Markov microsimulation model to compare results under the present US liver allocation policy with outcomes under a "Rule 14" policy of barring patients with a MELD score of Յ14 from the waitlist or transplantation. For probabilities in the microsimulation model, we used data on all adult patients (Ն18 years) listed for or undergoing primary liver transplantation in the United States for chronic liver disease from 1/1/2003 through 12/31/2007 with follow-up until 2/1/2008. The "Rule 14" policy gave a 3% improvement in overall patient survival over the present system at 1, 2, 3, and 4 years and predicted a 13% decrease in overall waitlist time for patients with MELD scores of 15 to 40. Patients with the greatest benefit from a "Rule 14" policy were those with MELD scores of 6 to 10, for whom a 17% survival advantage was predicted from waiting on the list versus undergoing transplantation. Our analysis supports changing the national liver allocation policy to not allow liver transplantation for patients with MELD Յ 14.