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The model for end‐stage liver disease allocation system for liver transplantation saves lives, but increases morbidity and cost: a prospective outcome analysis
Author(s) -
Dutkowski Philipp,
Oberkofler Christian E.,
Béchir Markus,
Müllhaupt Beat,
Geier Andreas,
Raptis Dimitri A.,
Clavien PierreAlain
Publication year - 2011
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.22228
Subject(s) - medicine , liver transplantation , model for end stage liver disease , liver disease , transplantation , surgery
We analyzed the first 100 patients who underwent liver transplantation by Model for End‐Stage Liver Disease (MELD) allocation, and compared the outcome of patients on the waiting list and after orthotopic liver transplantation with the last 100 patients who underwent transplantation prior to the introduction of the MELD system in July 2007. MELD allocation resulted in decreased waiting list mortality (386 versus 242 deaths per 1000 patient‐years, P < 0.0001) and the transplantation of sicker recipients (uncorrected median MELD score 13.5 versus 20, P = 0.003). Recipient posttransplant morbidity was significantly higher, mainly caused by increased percentage of renal failure requiring renal replacement therapy (13 versus 46%, P < 0.0001). However, kidney function recovered in most cases within 6 months after OLT. Hospital mortality remained similar in both groups (6% versus 9%). Patient 1‐year survival was 91% versus 83% (pre‐MELD versus MELD era, P = 0.2154), graft 1‐year survival was 88% versus 78% ( P = 0.1013), respectively. Costs accumulated were significantly higher after introduction of the MELD policy (US $81,967 versus US $127,453, a 55% increase, P = 0.02) with a strong correlation with the individual MELD score ( P < 0.0001). The MELD system addresses the goal of fairness well. However, the postoperative course appears more difficult in the MELD era with increased financial burden, but reasonable patient and graft survival. This is the inevitable price to balance justice and utility in liver graft allocation. Liver Transpl 17:674–684, 2011. © 2011 AASLD.