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Higher Mortality in registrants with sudden model for end‐stage liver disease increase: Disadvantaged by the current allocation policy
Author(s) -
Massie Allan B.,
Luo Xun,
Alejo Jennifer L.,
Poon Anna K.,
Cameron Andrew M.,
Segev Dorry L.
Publication year - 2015
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.24102
Subject(s) - medicine , liver transplantation , model for end stage liver disease , liver disease , spike (software development) , demography , transplantation , management , sociology , economics
Liver allocation is based on current Model for End‐Stage Liver Disease (MELD) scores, with priority in the case of a tie being given to those waiting the longest with a given MELD score. We hypothesized that this priority might not reflect risk: registrants whose MELD score has recently increased receive lower priority but might have higher wait‐list mortality. We studied wait‐list and posttransplant mortality in 69,643 adult registrants from 2002 to 2013. By likelihood maximization, we empirically defined a MELD spike as a MELD increase ≥ 30% over the previous 7 days. At any given time, only 0.6% of wait‐list patients experienced a spike; however, these patients accounted for 25% of all wait‐list deaths. Registrants who reached a given MELD score after a spike had higher wait‐list mortality in the ensuing 7 days than those with the same resulting MELD score who did not spike, but they had no difference in posttransplant mortality. The spike‐associated wait‐list mortality increase was highest for registrants with medium MELD scores: specifically, 2.3‐fold higher (spike versus no spike) for a MELD score of 10, 4.0‐fold higher for a MELD score of 20, and 2.5‐fold higher for a MELD score of 30. A model incorporating the MELD score and spikes predicted wait‐list mortality risk much better than a model incorporating only the MELD score. Registrants with a sudden MELD increase have a higher risk of short‐term wait‐list mortality than is indicated by their current MELD score but have no increased risk of posttransplant mortality; allocation policy should be adjusted accordingly. Liver Transpl 21:683–689, 2015 . © 2015 AASLD.