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Should liver transplantation in patients with model for end‐stage liver disease scores ≤ 14 be avoided? A decision analysis approach
Author(s) -
Perkins James D.,
Halldorson Jeffrey B.,
Bakthavatsalam Ramasamy,
Fix Oren K.,
Carithers Robert L.,
Reyes Jorge D.
Publication year - 2009
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21703
Subject(s) - medicine , liver transplantation , liver disease , model for end stage liver disease , stage (stratigraphy) , transplantation , intensive care medicine , paleontology , biology
Studies have shown that liver transplantation offers no survival benefits to patients with Model for End‐Stage Liver Disease (MELD) scores ≤ 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 ≤14 from the waitlist or transplantation. For probabilities in the microsimulation model, we used data on all adult patients (≥18 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 ≤ 14. Liver Transpl 15:242–254, 2009. © 2009 AASLD.