In the United States, the Model for End-Stage Liver. Re-weighting the Model for End-Stage Liver Disease Score Components

Size: px
Start display at page:

Download "In the United States, the Model for End-Stage Liver. Re-weighting the Model for End-Stage Liver Disease Score Components"

Transcription

1 GASTROENTEROLOGY 2008;135: Re-weighting the Model for End-Stage Liver Disease Score Components PRATIMA SHARMA,* DOUGLAS E. SCHAUBEL,, CAMELIA S. SIMA,, ROBERT M. MERION,, and ANNA S. F. LOK* *Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor; Department of Biostatistics, University of Michigan, Ann Arbor; Scientific Registry of Transplant Recipients, Ann Arbor; Arbor Research Collaborative for Health, Ann Arbor, Michigan; and Department of Surgery, University of Michigan, Ann Arbor, Michigan Background & Aims: Liver transplant candidates with mild hepatic synthetic dysfunction and marked renal insufficiency may have higher Model for End- Stage Liver Disease (MELD) scores than candidates with severe liver disease and normal renal function. We re-estimated MELD coefficients and evaluated the effect of updated MELD on the liver transplant waiting list ranking. Methods: Scientific Registry of Transplant Recipients data was analyzed for 38,899 adults wait-listed between September, 2001 and December, A time-dependent Cox regression waiting list mortality model estimated updated MELD component coefficients. Rank correlation between existing and updated MELD scores was computed. Results: Existing MELD component coefficient (log e creatinine, vs [95% confidence interval (CI), ]; log e bilirubin, vs [95% CI, ]; log e international normalized ratio, vs [95% CI, ]) was significantly different than updated counterpart. Index of concordance was higher for updated MELD than existing MELD for predicting overall (0.68 vs. 0.64) and 90-day waiting list mortality (0.77 vs. 0.75). Rank correlation between existing and updated MELD scores was 0.95 for all candidates and 0.72 for candidates with existing MELD >20. Among candidates with equal existing MELD, those with lower creatinine and higher bilirubin had significantly higher waiting list mortality. Conclusions: Existing MELD coefficient components are significantly different than those calculated from national waiting list data. Updated MELD assigns lower weight to creatinine and international normalized ratio and higher weight to bilirubin. Updated MELD better predicts waiting list mortality. Using updated MELD for liver allocation would alter waiting list candidate ranking. In the United States, the Model for End-Stage Liver Disease (MELD) score was adopted as the basis for national liver allocation for candidates with chronic liver disease on February 27, The MELD is a mortality score based on objective laboratory values of total bilirubin, international normalized ratio (INR) of prothrombin time, and serum creatinine. 1 It was derived from a cohort of 231 patients undergoing elective transjugular intrahepatic portosystemic shunt procedure. 2 The MELD score has been shown to be superior to Child Turcotte Pugh score in predicting waiting list mortality. 3 6 Wiesner et al applied the MELD model prospectively to a cohort of 3437 adult liver transplantation candidates listed with United Network for Organ Sharing status 2A and 2B and found a good correlation between the listing MELD score and the 3-month mortality on the waiting list. 1 The MELD-based allocation system appears to be working well. Within 6 months of its implementation, prevalent waiting list registrations decreased for the first time, and waiting list mortality was lower. 7 However, compared with the pre-meld era, a significantly higher proportion of recipients were receiving renal replacement therapy (RRT) at the time of liver transplantation. In a recent analysis of the Scientific Registry of Transplant Recipients database, the proportion of candidates with creatinine 2.0 mg/dl undergoing liver transplantation from April of 1999 to December of 2004 increased from 7.9% in the pre-meld era to 10% in the post-meld era. 8 Since the adoption of MELD, the number of combined liver and kidney transplants also increased from 2.6% in 2001 to 5.2% in These analyses reflect that creatinine is heavily weighted in the existing MELD formula. Our hypothesis is that, given the same MELD score, the mortality risk of candidates with renal insufficiency is different than candidates with normal renal function. The specific aim of our study was to determine whether the previously established coefficients of the 3 components in the existing MELD formula optimally predict mortality risk among a contemporary cohort of patients on the waiting list for liver transplantation. Materials and Methods Data Source and Study Population The study used data from the Scientific Registry of Transplant Recipients for all listed adult candidates in Abbreviations used in this paper: IOC, Index of concordance; MELD, Model for End-Stage Liver Disease; RRT, renal replacement therapy by the AGA Institute /08/$34.00 doi: /j.gastro

2 1576 SHARMA ET AL GASTROENTEROLOGY Vol. 135, No. 5 the United States submitted by the members of the Organ Procurement and Transplantation Network and was supplemented by mortality information from the Social Security Death Master File. The study population included candidates 18 years of age and older with an initial date of registration for deceased donor liver transplant between September 1, 2001, and December 31, The start date of the study corresponded to the initial date of mandatory submission of the 3 components of the MELD score. Patients were followed to death, liver transplantation, loss to follow-up, or the end of the observation period on December 31, 2006, whichever occurred first. Candidates listed as status 1 or for retransplantation were excluded. Candidates were censored when listing was granted for status 1 or had an exception MELD score. Exception MELD scores are assigned for patients whose calculated score may not reflect the biologic nature of their disease. This is often true for patients with hepatocellular carcinoma, hepatopulmonary syndrome, and other metabolic disorders. Time at risk was censored starting when an exception MELD score was granted. Changes in MELD scores for patients with chronic liver disease while on the waiting list were tracked. A total of 235,311 sets of laboratory observations were used for the development of the updated MELD formula. Analytical Approach Re-estimation of MELD coefficients. The unbounded as well as the bounded mean and standard deviation of the listing MELD components were computed as summary statistics. In the existing MELD formula, values of bilirubin, creatinine, and INR less than 1.0 are set to 1.0 mg/dl to avoid negative values after natural logarithmic transformation. 6 Additionally, creatinine greater than 4.0 mg/dl with or without renal replacement therapy is capped at 4.0 mg/dl. 6 The bounding of creatinine at 1.0 mg/dl for values less than 1.0 mg/dl in the existing MELD formula implicitly assumes that mortality is constant for creatinine less than 1.0 mg/dl. A similar assumption is applied for bilirubin and INR. However, this assumption is problematic, especially for creatinine, for 2 reasons. First, the hypothetical increase in creatinine from 0.3 mg/dl to 0.6 mg/dl reflects a 50% decrease in the glomerular filtration rate. Second, a relatively large number of candidates are likely to have serum creatinine values 1.0 mg/dl at listing; this was the case in 61% of patients in this study. To re-estimate the MELD coefficients, a time-dependent Cox regression model was fitted with MELD components as predictors of mortality using serial unbounded laboratory values of each candidate. In a timedependent Cox model, a candidate s covariates are allowed to vary throughout the follow-up period. This model is more appropriate for this data structure because creatinine, bilirubin, and INR values change over time for most waiting list candidates and are recorded at multiple times. Using the baseline (time 0) values may underestimate the importance of each covariate. If laboratory values that change over time are treated as constant, then covariate misclassification occurs with increasing frequency as follow-up time increases. 10,11 The coefficients obtained from the time-dependent model were called the updated MELD coefficients. These updated coefficients (ie, the log e hazard ratios) reflected the effect of a 1-unit change in that component on the log e mortality hazard. The resulting formula was called the updated MELD. To preserve the nonnegative property of each component, yet retain the gradient at the low end, the components in the updated MELD were scored as log e (1 creatinine), log e (1 bilirubin), and log e (1 INR). Therefore, the lower bound for bilirubin and INR, and lower as well as upper bound of creatinine, were not employed in the updated MELD formula. The updated MELD assumed that the mortality risk increases linearly with increase in laboratory value for each component. To test this assumption, the models with each component were fitted. Each component was categorized into quartiles (the lowest quartile serving as the reference), and the coefficients from the refitted model were plotted against their respective category-specific medians. A linear trend was observed for each component validating this formula. To confirm further this assumption, a model restricted to patients with creatinine 1 was tested, and a linear trend was again observed. To determine whether adding 1 to each component laboratory value affects the accuracy of updated MELD, a model was fitted with the component scores as log e (x), similar to the existing MELD formula, as opposed to log e (1 x). The log likelihood was considerably higher for the log e (1 x) model. To account for the effect of RRT on waiting list mortality, RRT was tested as covariate in the model. RRT was defined as intermittent dialysis or continuous venovenous hemodiafiltration within a week of laboratory draw. Relative weight of each component. The weight of each MELD component was intended to reflect the importance of that component in determining a patient s MELD score, relative to the other 2 components. The specific method by which weight is computed is arbitrary, but it is preferable to use weights that are normalized to a sum of 1.0. As an example, the weight of creatinine can be computed as the ratio of the creatinine multiplier in MELD formula, divided by the sum of the multipliers for creatinine, bilirubin, and INR. Because the MELD coefficients are each intended to reflect the change in mortality rate per 1-unit change in the log e component, the above described weighting method would be appropriate if each of the components were equally variable across patients. However, as described in Table 1, this is not the

3 November 2008 REWEIGHTING MELD SCORE COMPONENTS 1577 case. For example, a 1-unit difference in log e (1 creatinine), with standard deviation of 0.37 is more extreme than a 1-unit change in log e (1 bilirubin) with standard deviation of To ensure that all 3 components were scaled similarly, each coefficient of the MELD at listing was multiplied by its standard deviation so that the product represented 1 standard deviation change. Weights were then calculated from these proportions. For example, the weight of creatinine was computed as follows: Wt c C SD C C SD C B SD B I SD I, where C, B, and I denote the estimated coefficient (log e hazard ratio) for log e (1 creatinine), log e (1 bilirubin) and log e (1 INR), respectively, whereas SD C,SD B, and SD I denote the empirical standard deviation of the respective components. The standard deviation of bounded laboratory values was used to calculate the relative weights in the existing MELD formula, and the standard deviation of unbounded laboratory values was used to Table 1. Characteristics of 38,899 Liver Transplant Candidates at the Time of Listing Candidate characteristics Mean SD (range) or percent Age at listing, y (18 83) Sex Male 65.2 Female 34.8 Race White 73.2 African American 7.7 Asian 3.9 Hispanic 14.3 Other 0.9 Etiology of liver disease Noncholestatic liver disease 73.5 Cholestatic liver disease 5.2 Acute hepatic necrosis 4.4 Metabolic disease 1.8 Malignant neoplasm 2.3 Others 12.3 MELD score (6 40) MELD components at listing Creatinine (mg/dl) Bilirubin (mg/dl) INR Log e transformation of MELD components at listing Bounded log e (1 component) Unbounded log e (1 component) Creatinine Bilirubin INR NOTE. For bounded values: Creatinine values less than 1.0 mg/dl were set to 1.0 mg/dl, and values higher than 4.0 mg/dl or candidates receiving dialysis were set to 4.0 mg/dl. Bilirubin values less than 1.0 mg/dl were set to 1.0 mg/dl, and INR values less than 1.0 were set to 1.0. SD, standard deviation. calculate the relative weights in the updated MELD formula. Stratified analysis. To examine the mortality risk on the waiting list because of changes in each MELD component among candidates with the same existing MELD score, 3 additional Cox models were fitted separately for each MELD component, stratified by existing MELD scores, ie, using a separate stratum for each level of MELD (6 to 40). Hazard ratios (HR) derived from each model reflected the mortality risk on the waiting list because of changes in each MELD component among candidates with the same existing MELD score. Rank correlation. To assess the impact of the updated MELD score on the ranking of waiting list candidates, the Spearman rank correlation coefficient between the existing and updated MELD scores was computed. For this part of the analysis, 4 cross sections of patients were selected who had not been granted a MELD score exception and were alive and active on the waiting list on January 1 of each of the following years: 2002, 2003, 2004, and Model validation. The original cohort was randomly split into 2 equally sized training and validation data sets. The updated MELD score for the validation data set was computed based on a model fitted to the training data set. The index of concordance (IOC) was used to estimate the goodness of fit for the models. 12 The IOC represents the percentage of pairs of subjects where there is concordance between the predicted and observed ordering of outcomes. An IOC of 1.0 indicates perfect identification of the relative survival of all possible pairs of patients, whereas an IOC of 0.5 indicates that the model is no more predictive than chance. 12,13 The IOC for a time-dependent Cox regression model is analogous to the C-statistic computed from the area under the receiver operating characteristic curve for logistic regression models. All candidates in the validation data set with observed time to death were considered to compute the IOC using the existing and updated MELD formulae. Results Characteristics of the Study Population at the Time of Listing Figure 1 summarizes the disposition of the study population. A total of 42,953 adult candidates were initially placed on the liver transplant waiting list between September 1, 2001, and December 31, A total of 4054 candidates were excluded: 1717 were listed as status 1, whereas 2337 were listed with an exception score. Among the 38,899 candidates in the cohort analyzed, 6490 candidates died, 15,318 underwent transplantation, and 10,677 candidates were still waiting on the list at the end of the study period. Characteristics of the liver transplant candidates at the time of listing are shown in Table 1. The mean age was 52

4 1578 SHARMA ET AL GASTROENTEROLOGY Vol. 135, No. 5 Figure 1. Cohort description. Adult candidates listed for liver transplant between September 1, 2001, and December 31, Data source: Scientific Registry of Transplant Recipients. *Overlapping categories. Abbreviations: DDLT, deceased donor liver transplantation; LDLT, living donor liver transplantation. years, 65% were male, 73% were white, and 74% had noncholestatic liver disease. The mean MELD score at listing was The mean serum creatinine, bilirubin, and INR values at the time of listing were 1.27 mg/dl, 4.67 mg/dl, and 1.54, respectively. Coefficients and Relative Weights of Updated vs Existing MELD Formula The updated MELD formula derived from the time-dependent model is based on all the serial creatinine, bilirubin, and INR values in the Scientific Registry of Transplant Recipients database for the study cohort. The final model is represented as follows: Updated MELD log e (1 creatinine) log e (1 bilirubin) log e (1 INR). As shown in Table 2, when the updated MELD formula was compared with the existing MELD formula, the coefficient for each component in the existing formula was outside the 95% confidence interval for the updated coefficient. Thus, the coefficients for each component in the existing and updated MELD formulae were significantly different. The effect of RRT was nonsignificant (P.88), and, therefore, RRT was not incorporated into the updated MELD formula. Calculation of the relative weight of each MELD component for the existing and updated MELD formulae is shown in Table 3. The relative weights of log e (1 creatinine) and log e (1 INR) in the updated MELD formula were lower than the relative weights of log e creatinine and log e INR in the existing MELD formula. However, the relative weight was higher for log e (1 bilirubin) in the updated MELD than log e bilirubin in the existing MELD. The relative weights of the coefficients of all 3 MELD components in the existing formula were outside the 95% confidence interval of the coefficient weights in the updated MELD formula. Predictive Ability of Updated MELD Across All Age and Race/Ethnicity Groups The effect of updated MELD was tested across the age groups (18 39, 40 49, 50 59, and 60 years) and race/ethnicity groups (white, Asian, African American, Hispanic, and other). The updated MELD was also highly predictive of waiting list mortality in each age group (all P.0001) and race/ethnicity group (all P.0001). Stratified Analysis In the stratified analysis, within each MELD stratum, candidates with higher serum creatinine (and, by definition, lower bilirubin and/or INR to result in the same MELD score) had significantly lower mortality (HR, 0.89; P.001) than candidates with lower serum creatinine (and therefore higher bilirubin and/or INR). In contrast, patients at the same MELD score with higher bilirubin had significantly higher mortality (HR, 1.10; P.0001), whereas those with higher INR had an increased mortality risk (HR, 1.10; P.11), which was nonsignificant. Rank Correlation The rank correlation of 4 waiting list cross sections using existing and updated MELD scores for all patients was However, the correlation was 0.72 when the analysis was restricted to candidates with existing MELD score 20. Figure 2 shows that the correlation between MELD scores computed using existing and updated formulae was excellent for existing MELD scores of 15 and lower. Figure 3 represents the distribution of updated MELD scores among candidates with tied existing MELD scores. At existing MELD scores 15, there was a tight distribution of corresponding updated MELD scores; however, at existing MELD scores above 15, there was considerable variability and overlap in updated MELD scores. Validation As expected, the updated MELD coefficients obtained from the model data set were similar to those for the entire data set (Table 2), being 1.228, 0.913, and Table 2. Comparison of Coefficients of MELD Components in Updated and Existing MELD Formula Log e MELD components Coefficients Updated MELD a estimate (95% CI) Existing MELD Log e creatinine ( ) Log e bilirubin ( ) Log e INR ( ) 1.12 a Based on log e (1 component).

5 November 2008 REWEIGHTING MELD SCORE COMPONENTS 1579 Table 3. Calculation of Relative Weights of MELD Components in Existing and Updated MELD Formula MELD component MELD coefficient SD Coefficient SD Relative weight a Relative weight calculation: existing MELD Existing coefficient Bounded values Log e creatinine b Log e bilirubin Log e INR Column sum n/r n/r Relative weight calculation: updated MELD Updated coefficient Unbounded values Coefficient SD Relative weight (95% CI) Log e (1 creatinine) c ( ) Log e (1 bilirubin) ( ) Log e (1 INR) ( ) Column sum n/r n/r SD, standard deviation; n/r, not relevant. a Adjustment of coefficient SD to a sum of 1. b 0.357/ c 0.399/ for log e (1 creatinine), log e (1 bilirubin), and log e (1 INR), respectively. Table 4 shows the comparison of the IOC for existing and updated MELD formulae in predicting all mortality and 90-day mortality on the waiting list. For all patients, the IOC was 0.64 using the existing MELD score and 68% for the updated MELD score. When the analysis was restricted to patients with MELD score 30, the index of concordance was slightly higher for the updated MELD (0.7) and was lower for the existing MELD score (0.61). The IOC was considerably higher when evaluating 90-day waiting list mortality (0.75 vs 0.77 for existing and updated MELD, respectively). Discussion The MELD for liver allocation policy was adopted with the goal of offering deceased donor organs to the candidate at the highest risk of death in the absence of a transplant. 14 After implementation of MELD-based allocation, there was a 12% reduction in the size of the liver transplant waiting list and an 11% decrease in waiting list deaths within the first 6 months of its implementation. 15 Although several studies validated the MELD as a predictor of waiting list mortality, these studies focused on short-term mortality, and analyses were restricted to the MELD score at the time of placement on the waiting list. 1,4 6 This study used a much larger cohort of 38,899 liver transplantation candidates and all sets of laboratory values of creatinine, bilirubin, and INR while on the waiting list to derive an updated MELD formula using a time-dependent Cox regression model. The data from this study showed that the coefficient of each component of MELD in the updated formula was significantly different from the respective coefficient in the existing MELD formula. Similarly, the relative weight of each component of MELD in the updated formula was significantly different than the corresponding weight in the existing MELD formula. The updated MELD formula was associated with a lower relative weight for serum creatinine and a higher relative weight for bilirubin. The Figure 2. Rank correlation between existing and updated MELD at different MELD categories. Figure 3. Distribution of updated MELD scores among patients with selected existing MELD scores. Box-and-whisker plot: Each box contains the middle 50% of the data; the whiskers represent the 5th and 95th percentiles of the data. Data derived from 10 cross sections of wait list.

6 1580 SHARMA ET AL GASTROENTEROLOGY Vol. 135, No. 5 Table 4. Model Validation: Index of Concordance for Existing and Updated MELD Scores in Predicting All Mortality and 90-Day Mortality on the Waiting List Index of concordance, all mortality Index of concordance, 90-day mortality MELD scores Existing MELD Updated MELD Existing MELD Updated MELD updated MELD also predicted waiting list mortality accurately for all subgroups defined by age and race/ethnicity. These observations suggest that updated MELD, if implemented, would be applicable for adults of any age and/or race/ethnicity. The stratified analysis in this study provides additional evidence in support for our hypothesis that creatinine is overweighted in the existing MELD formula. Within each MELD stratum, candidates with higher serum creatinine had lower waiting list mortality compared with those with lower creatinine, whereas those with higher serum bilirubin had higher mortality on the waiting list. These data indicate that, among candidates with the same MELD score computed according to the existing formula, those with markedly impaired renal function and less severe liver disease had lower waiting list mortality than those with better preserved renal function and more severe liver dysfunction. The analyses from this study suggest that updated MELD was superior to existing MELD in predicting all mortality as well as 90-day mortality on the waiting list. The overall rank correlation among all candidates was excellent despite significant differences in coefficients and relative weights of the coefficients of each MELD component between the existing and updated MELD formulas. However, for patients with high MELD scores ( 20), who have both the highest risk of dying without transplant and the highest likelihood of being offered a donor organ under MELD-based allocation, the rank correlation was only These data suggest that the ordering of many candidates with MELD scores 20 would change if updated MELD were implemented. The strength of this study is that it used national data from a cohort of 38,899 candidates and a time-dependent analysis to predict waiting list mortality. The time-dependent analysis predicts waiting list mortality risk more accurately than a model based only on the MELD score at listing because it takes into account the altered risk associated with changes in MELD score after listing. If the updated MELD formula described herein were used for liver allocation, the rankings of candidates near the top of the waiting list would be different. Specifically, candidates with more severe liver synthetic dysfunction and less renal insufficiency will be higher on the list than other candidates with less severe liver synthetic dysfunction but more severe renal insufficiency. Candidates with type 1 hepatorenal syndrome would still be at the top of the waiting list because they usually have high bilirubin and INR as well as high creatinine. However, ranking would be lower for patients with intrinsic kidney disease and mild liver synthetic dysfunction. Our data suggest that application of the updated MELD formula may be associated with reduction in waiting list mortality. Data from previous studies suggest that recipients with moderate to severe renal insufficiency at the time of liver transplantation have a higher incidence of primary graft nonfunction, more infections, longer posttransplantation intensive care unit stays, and lower patient and graft survival rates compared with otherwise similar recipients with less serious renal dysfunction at the time of transplantation. 8,16,17 We speculate that application of the updated MELD formula would also result in improvement of posttransplantation morbidity and mortality. One limitation of the current study is that serum creatinine values from an observational database may not reflect an accurate assessment of steady state renal function in cirrhotic patients. In the existing MELD formula, serum creatinine is capped at 4.0 mg/dl. The intent of the updated MELD formula was to use the full range of laboratory values, but this was not possible for candidates undergoing RRT in whom serum creatinine values were artificially lowered. In the existing MELD score, candidates with creatinine 4.0 mg/dl and/or on RRT are assigned a creatinine of 4.0 mg/dl. This cut off was implemented arbitrarily in the implementation of MELD-based allocation by the Organ Procurement and Transplantation Network. In this study, we evaluated the effect of RRT on mortality using the unbounded updated MELD score and did not find it to be a significant independent predictor of mortality on the waiting list. Based on these analyses, therefore, we feel that the updated MELD equation could be implemented even in the presence of RRT. In conclusion, institution of MELD-based liver allocation was an important event in the history of liver transplantation. However, evidence-based process improvement and quality assessment of any policy is required to further enhance and improve the outcomes. The results

7 November 2008 REWEIGHTING MELD SCORE COMPONENTS 1581 of this study represent the continuing evolution of the MELD. Incorporating the coefficients from the updated MELD formula into the national liver allocation policy would represent incremental progress toward the goal of accurately gauging the relative risk of waiting list mortality among those awaiting liver transplantation. References 1. Wiesner R, Edwards E, Freeman R, et al. Model for End-Stage Liver Disease (MELD) and allocation of donor livers. Gastroenterology 2003;124: Malinchoc M, Kamath PS, Gordon FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts. Hepatology 2000;31: Huo TI, Wu JC, Lin HC, et al. Evaluation of the increase in Model for End-Stage Liver Disease (DeltaMELD) score over time as a prognostic predictor in patients with advanced cirrhosis: risk factor analysis and comparison with initial MELD and Child-Turcotte-Pugh score. J Hepatol 2005;42: Heuman DM, Mihas A. Utility of the MELD score for assessing 3-month survival in patients with liver cirrhosis: one more positive answer. Gastroenterology 2003;125: Wiesner RH, Edwards E, Kamath P. Mayo End-Stage Liver Disease (MELD) model predicts liver transplant waiting list mortality: implications for liver allocation policy. Transplantation 2001;71: Kim W, Kremers W, Malinchoc M, et al. Determinant of death on liver transplant waiting list: waiting time, blood group or MELD? Hepatology 2001;34:204A. 7. Merion RM, Rush SH, Dykstra DM, et al. Predicted lifetimes for adult and pediatric split liver versus adult whole liver transplant recipients. Am J Transplant 2004;4: Gonwa TA, McBride MA, Anderson K, et al. Continued influence of preoperative renal function on outcome of orthotopic liver transplant (OLTX) in the US: where will MELD lead us? Am J Transplant 2006;6: Pomfret EA, Fryer JP, Sima CS, et al. Liver and intestine transplantation in the United States, Am J Transplant 2007;7(Suppl 1): Kalbfleisch JD, Prentice RL. The statistical analysis of failure time data. New York: Wiley, Allison PD. Survival analysis using SAS: a practical guide. Cary, NC: SAS Institute, Harrell FE Jr, Lee KL, Mark DB. Multivariable prognostic models: issues in developing models, evaluating assumptions and adequacy, and measuring and reducing errors. Stat Med 1996;15: Schemper M, Stare J. Explained variation in survival analysis. Stat Med 1996;15: Anonymous. Organ procurement and transplant network-hrsa. Final rule with comment period. Federal Register 1998;63: Brown RS, Rush SH, Rosen HR, et al. Liver and intestine transplantation. Am J Transplant 2004;4(Suppl 9): Nair S, Verma S, Thuluvath PJ. Pretransplant renal function predicts survival in patients undergoing orthotopic liver transplantation. Hepatology 2002;35: Narayanan Menon KV, Nyberg SL, Harmsen WS, et al. MELD and other factors associated with survival after liver transplantation. Am J Transplant 2004;4: Received October 22, Accepted August 7, Address requests for reprints to: Anna S. F. Lok, MD, Professor of Medicine, Division of Gastroenterology, University of Michigan Health System, 3912 Taubman Center, SPC 5362, Ann Arbor, Michigan aslok@med.umich.edu; fax: (734) Supported by the Scientific Registry of Transplant Recipients funded by contract number from the Health Resources and Services Administration, US Department of Health and Human Services. The statistical methodology development and analysis for this investigation was supported by the National Institutes of Health grant R01 DK (to D.E.S.). The views expressed in this paper are those of the authors and are not necessarily those of the US government. The authors thank Shauna Leighton, medical editor, Arbor Research Collaborative for Health, Ann Arbor, Michigan, funded by the Scientific Registry of Transplant Recipients, for providing editorial assistance. These findings were presented as an oral presentation at American Transplant Congress, 2007, held in San Francisco, California. The authors disclose no conflicts.

Geographic Differences in Event Rates by Model for End-Stage Liver Disease Score

Geographic Differences in Event Rates by Model for End-Stage Liver Disease Score American Journal of Transplantation 2006; 6: 2470 2475 Blackwell Munksgaard C 2006 The Authors Journal compilation C 2006 The American Society of Transplantation and the American Society of Transplant

More information

Serum Sodium and Survival Benefit of Liver Transplantation

Serum Sodium and Survival Benefit of Liver Transplantation LIVER TRANSPLANTATION 21:308 313, 2015 ORIGINAL ARTICLE Serum Sodium and Survival Benefit of Liver Transplantation Pratima Sharma, 1 Douglas E. Schaubel, 2 Nathan P. Goodrich, 4 and Robert M. Merion 3,4

More information

The pediatric end-stage liver disease (PELD) score

The pediatric end-stage liver disease (PELD) score Selection of Pediatric Candidates Under the PELD System Sue V. McDiarmid, 1 Robert M. Merion, 2 Dawn M. Dykstra, 2 and Ann M. Harper 3 Key Points 1. The PELD score accurately predicts the 3 month probability

More information

Organ allocation for liver transplantation: Is MELD the answer? North American experience

Organ allocation for liver transplantation: Is MELD the answer? North American experience Organ allocation for liver transplantation: Is MELD the answer? North American experience Douglas M. Heuman, MD Virginia Commonwealth University Richmond, VA, USA March 1998: US Department of Health and

More information

Following the introduction of adult-to-adult living

Following the introduction of adult-to-adult living LIVER FAILURE/CIRRHOSIS/PORTAL HYPERTENSION Liver Transplant Recipient Survival Benefit with Living Donation in the Model for Endstage Liver Disease Allocation Era Carl L. Berg, 1 Robert M. Merion, 2 Tempie

More information

ORIGINAL ARTICLE Gastroenterology & Hepatology INTRODUCTION

ORIGINAL ARTICLE Gastroenterology & Hepatology INTRODUCTION ORIGINAL ARTICLE Gastroenterology & Hepatology http://dx.doi.org/10.3346/jkms.2013.28.8.1207 J Korean Med Sci 2013; 28: 1207-1212 The Model for End-Stage Liver Disease Score-Based System Predicts Short

More information

Improving liver allocation: MELD and PELD

Improving liver allocation: MELD and PELD American Journal of Transplantation 24; 4 (Suppl. 9): 114 131 Blackwell Munksgaard Blackwell Munksgaard 24 Improving liver allocation: MELD and PELD Richard B. Freeman Jr a,, Russell H. Wiesner b, John

More information

Survival Benefit-Based Deceased-Donor Liver Allocation

Survival Benefit-Based Deceased-Donor Liver Allocation American Journal of Transplantation 2009; 9 (Part 2): 970 981 Wiley Periodicals Inc. No claim to original US government works Journal compilation C 2009 The American Society of Transplantation and the

More information

Clinical Study The Impact of the Introduction of MELD on the Dynamics of the Liver Transplantation Waiting List in São Paulo, Brazil

Clinical Study The Impact of the Introduction of MELD on the Dynamics of the Liver Transplantation Waiting List in São Paulo, Brazil Transplantation, Article ID 219789, 4 pages http://dx.doi.org/1.1155/214/219789 Clinical Study The Impact of the Introduction of MELD on the Dynamics of the Liver Transplantation Waiting List in São Paulo,

More information

Survival Outcomes Following Liver Transplantation (SOFT) Score: A Novel Method to Predict Patient Survival Following Liver Transplantation

Survival Outcomes Following Liver Transplantation (SOFT) Score: A Novel Method to Predict Patient Survival Following Liver Transplantation American Journal of Transplantation 2008; 8: 2537 2546 Wiley Periodicals Inc. C 2008 The Authors Journal compilation C 2008 The American Society of Transplantation and the American Society of Transplant

More information

Predictors of cardiac allograft vasculopathy in pediatric heart transplant recipients

Predictors of cardiac allograft vasculopathy in pediatric heart transplant recipients Pediatr Transplantation 2013: 17: 436 440 2013 John Wiley & Sons A/S. Pediatric Transplantation DOI: 10.1111/petr.12095 Predictors of cardiac allograft vasculopathy in pediatric heart transplant recipients

More information

ORIGINAL ARTICLE. Did the New Liver Allocation Policy Affect Waiting List Mortality?

ORIGINAL ARTICLE. Did the New Liver Allocation Policy Affect Waiting List Mortality? ORIGINAL ARTICLE Model for End-stage Liver Disease Did the New Liver Allocation Policy Affect Waiting List Mortality? Mary T. Austin, MD, MPH; Benjamin K. Poulose, MD, MPH; Wayne A. Ray, PhD; Patrick G.

More information

Death in patients waiting for liver transplantation. Liver Transplant Recipient Selection: MELD vs. Clinical Judgment

Death in patients waiting for liver transplantation. Liver Transplant Recipient Selection: MELD vs. Clinical Judgment ORIGINAL ARTICLES Liver Transplant Recipient Selection: MELD vs. Clinical Judgment Michael A. Fink, 1,2 Peter W. Angus, 1 Paul J. Gow, 1 S. Roger Berry, 1,2 Bao-Zhong Wang, 1,2 Vijayaragavan Muralidharan,

More information

2 Biostatistics and 3 Surgery, University of Michigan, Ann

2 Biostatistics and 3 Surgery, University of Michigan, Ann LIVER TRANSPLANTATION 22:71 79, 2016 ORIGINAL ARTICLE Propensity Score-Based Survival Benefit of Simultaneous Liver-Kidney Transplant Over Liver Transplant Alone for Recipients With Pretransplant Renal

More information

TEMPORAL PREDICTION MODELS FOR MORTALITY RISK AMONG PATIENTS AWAITING LIVER TRANSPLANTATION

TEMPORAL PREDICTION MODELS FOR MORTALITY RISK AMONG PATIENTS AWAITING LIVER TRANSPLANTATION Proceedings of the 3 rd INFORMS Workshop on Data Mining and Health Informatics (DM-HI 2008) J. Li, D. Aleman, R. Sikora, eds. TEMPORAL PREDICTION MODELS FOR MORTALITY RISK AMONG PATIENTS AWAITING LIVER

More information

ORIGINAL ARTICLE. Eric F. Martin, 1 Jonathan Huang, 3 Qun Xiang, 2 John P. Klein, 2 Jasmohan Bajaj, 4 and Kia Saeian 1

ORIGINAL ARTICLE. Eric F. Martin, 1 Jonathan Huang, 3 Qun Xiang, 2 John P. Klein, 2 Jasmohan Bajaj, 4 and Kia Saeian 1 LIVER TRANSPLANTATION 18:914 929, 2012 ORIGINAL ARTICLE Recipient Survival and Graft Survival are Not Diminished by Simultaneous Liver-Kidney Transplantation: An Analysis of the United Network for Organ

More information

USE OF A CONDITIONAL QUANTILES METHOD TO PREDICT FUTURE HEALTH OUTCOMES BASED ON THE TRAJECTORY OF PEDIATRIC END-STAGE LIVER DISEASE (PELD) SCORES

USE OF A CONDITIONAL QUANTILES METHOD TO PREDICT FUTURE HEALTH OUTCOMES BASED ON THE TRAJECTORY OF PEDIATRIC END-STAGE LIVER DISEASE (PELD) SCORES USE OF A CONDITIONAL QUANTILES METHOD TO PREDICT FUTURE HEALTH OUTCOMES BASED ON THE TRAJECTORY OF PEDIATRIC END-STAGE LIVER DISEASE (PELD) SCORES by YuZhou Liu B.S in Actuarial Mathematics, University

More information

Development of the Allocation System for Deceased Donor Liver Transplantation

Development of the Allocation System for Deceased Donor Liver Transplantation Clinical Medicine & Research Volume 3, Number 2: 87-92 2005 Marshfield Clinic http://www.clinmedres.org Review Development of the Allocation System for Deceased Donor Liver Transplantation John M. Coombes,

More information

Effect of Body Mass Index on the Survival Benefit of Liver Transplantation

Effect of Body Mass Index on the Survival Benefit of Liver Transplantation LIVER TRANSPLANTATION 13:1678-1683, 2007 ORIGINAL ARTICLE Effect of Body Mass Index on the Survival Benefit of Liver Transplantation Shawn J. Pelletier, 1 Douglas E. Schaubel, 2,3 Guanghui Wei, 2 Michael

More information

Sex-Based Disparities in Liver Transplant Rates in the United States

Sex-Based Disparities in Liver Transplant Rates in the United States American Journal of Transplantation 2011; 11: 1435 1443 Wiley Periodicals Inc. C 2011 The Authors Journal compilation C 2011 The American Society of Transplantation and the American Society of Transplant

More information

The MELD Score in Advanced Liver Disease: Association with Clinical Portal Hypertension and Mortality

The MELD Score in Advanced Liver Disease: Association with Clinical Portal Hypertension and Mortality The MELD Score in Advanced Liver Disease: Association with Clinical Portal Hypertension and Mortality Sammy Saab, 1,2 Carmen Landaverde, 3 Ayman B Ibrahim, 2 Francisco Durazo, 1,2 Steven Han, 1,2 Hasan

More information

Simultaneous Liver Kidney Allocation Policy: A Proposal to Optimize Appropriate Utilization of Scarce Resources

Simultaneous Liver Kidney Allocation Policy: A Proposal to Optimize Appropriate Utilization of Scarce Resources American Journal of Transplantation 2016; 16: 758 766 Wiley Periodicals Inc. Special Article Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons doi:

More information

Racial and Ethnic Disparities in Access to Liver Transplantation

Racial and Ethnic Disparities in Access to Liver Transplantation LIVER TRANSPLANTATION 16:1033-1040, 2010 ORIGINAL ARTICLE Racial and Ethnic Disparities in Access to Liver Transplantation Amit K. Mathur, 1 Douglas E. Schaubel, 2,3 Qi Gong, 2 Mary K. Guidinger, 3,4 and

More information

User Guide. A. Program Summary B. Waiting List Information C. Transplant Information

User Guide. A. Program Summary B. Waiting List Information C. Transplant Information User Guide This report contains a wide range of useful information about the kidney transplant program at (FLMR). The report has three main sections: A. Program Summary B. Waiting List Information The

More information

Cirrhosis secondary to chronic hepatitis C viral

Cirrhosis secondary to chronic hepatitis C viral Effect of Alcoholic Liver Disease and Hepatitis C Infection on Waiting List and Posttransplant Mortality and Transplant Survival Benefit Michael R. Lucey, 1 Douglas E. Schaubel, 2,3 Mary K. Guidinger,

More information

Factors associated with waiting time on the liver transplant list: an analysis of the United Network for Organ Sharing (UNOS) database

Factors associated with waiting time on the liver transplant list: an analysis of the United Network for Organ Sharing (UNOS) database ORIGINAL ARTICLE Annals of Gastroenterology (2018) 31, 1-6 Factors associated with waiting time on the liver transplant list: an analysis of the United Network for Organ Sharing (UNOS) database Judy A.

More information

Dynamics of the Romanian Waiting List for Liver Transplantation after Changing Organ Allocation Policy

Dynamics of the Romanian Waiting List for Liver Transplantation after Changing Organ Allocation Policy Dynamics of the Romanian Waiting List for Liver Transplantation after Changing Organ Allocation Policy Liana Gheorghe 1, Speranta Iacob 1, Razvan Iacob 1, Gabriela Smira 1, Corina Pietrareanu 1, Doina

More information

Liver and intestine transplantation: summary analysis,

Liver and intestine transplantation: summary analysis, American Journal of Transplantation 25; 5 (Part 2): 916 933 Blackwell Munksgaard Blackwell Munksgaard 25 Liver and intestine transplantation: summary analysis, 1994 23 Douglas W. Hanto a,, Thomas M. Fishbein

More information

Removing Patients from the Liver Transplant Wait List: A Survey of US Liver Transplant Programs

Removing Patients from the Liver Transplant Wait List: A Survey of US Liver Transplant Programs LIVER TRANSPLANTATION 14:303-307, 2008 ORIGINAL ARTICLE Removing Patients from the Liver Transplant Wait List: A Survey of US Liver Transplant Programs Kevin P. Charpentier 1 and Arun Mavanur 2 1 Rhode

More information

Prevalence and Outcomes of Multiple-Listing for Cadaveric Kidney and Liver Transplantation

Prevalence and Outcomes of Multiple-Listing for Cadaveric Kidney and Liver Transplantation American Journal of Transplantation 24; 4: 94 1 Blackwell Munksgaard Copyright C Blackwell Munksgaard 23 doi: 1.146/j.16-6135.23.282.x Prevalence and Outcomes of Multiple-Listing for Cadaveric Kidney and

More information

THE MODEL FOR END-STAGE

THE MODEL FOR END-STAGE ORIGINAL CONTRIBUTION Disparities in Liver Transplantation Before and After Introduction of the MELD Score Cynthia A. Moylan, MD Carla W. Brady, MD, MHS Jeffrey L. Johnson, MS Alastair D. Smith, MB, ChB

More information

Liver Transplantation for Alcoholic Liver Disease in the United States: 1988 to 1995

Liver Transplantation for Alcoholic Liver Disease in the United States: 1988 to 1995 Liver Transplantation for Alcoholic Liver Disease in the United States: 1988 to 1995 Steven H. Belle, Kimberly C. Beringer, and Katherine M. Detre T he Scientific Liver Transplant Registry (LTR) was established

More information

Supplementary Appendix

Supplementary Appendix Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Weintraub WS, Grau-Sepulveda MV, Weiss JM, et al. Comparative

More information

Despite recent advances in the care of patients with

Despite recent advances in the care of patients with Liver Transplantation for Hepatocellular Carcinoma: Lessons from the First Year Under the Model of End- Stage Liver Disease (MELD) Organ Allocation Policy Francis Y. Yao, 1,2 Nathan M. Bass, 1 Nancy L.

More information

What Is the Real Gain After Liver Transplantation?

What Is the Real Gain After Liver Transplantation? LIVER TRANSPLANTATION 15:S1-S5, 9 AASLD/ILTS SYLLABUS What Is the Real Gain After Liver Transplantation? James Neuberger Organ Donation and Transplantation, NHS Blood and Transplant, Bristol, United Kingdom;

More information

Access and Outcomes Among Minority Transplant Patients, , with a Focus on Determinants of Kidney Graft Survival

Access and Outcomes Among Minority Transplant Patients, , with a Focus on Determinants of Kidney Graft Survival American Journal of Transplantation 2010; 10 (Part 2): 1090 1107 Wiley Periodicals Inc. Special Feature No claim to original US government works Journal compilation C 2010 The American Society of Transplantation

More information

Should Liver Transplantation in Patients with Model for End-Stage Liver Disease Scores < 14 Be Avoided? A Decision Analysis Approach

Should Liver Transplantation in Patients with Model for End-Stage Liver Disease Scores < 14 Be Avoided? A Decision Analysis Approach LIVER TRANSPLANTATION 15:242-254, 2009 ORIGINAL ARTICLE Should Liver Transplantation in Patients with Model for End-Stage Liver Disease Scores < 14 Be Avoided? A Decision Analysis Approach James D. Perkins,

More information

Chronic liver failure affects multiple organ systems and

Chronic liver failure affects multiple organ systems and ORIGINAL ARTICLES Model for End-Stage Liver Disease (MELD) Predicts Nontransplant Surgical Mortality in Patients With Cirrhosis Patrick G. Northup, MD,* Ryan C. Wanamaker, MD, Vanessa D. Lee, MD, Reid

More information

Evidence-Based Incorporation of Serum Sodium Concentration Into MELD

Evidence-Based Incorporation of Serum Sodium Concentration Into MELD GASTROENTEROLOGY 2006;130:1652 1660 Evidence-Based Incorporation of Serum Sodium Concentration Into MELD SCOTT W. BIGGINS, W. RAY KIM, NORAH A. TERRAULT, SAMMY SAAB, VIJAY BALAN, THOMAS SCHIANO, JOANNE

More information

Impact of the Center on Graft Failure After Liver Transplantation

Impact of the Center on Graft Failure After Liver Transplantation LIVER TRANSPLANTATION 19:957 964, 2013 ORIGINAL ARTICLE Impact of the Center on Graft Failure After Liver Transplantation Sumeet K. Asrani, 1,6 W. Ray Kim, 1,2 Erick B. Edwards, 7 Joseph J. Larson, 3 Gabriel

More information

Ammonia level at admission predicts in-hospital mortality for patients with alcoholic hepatitis

Ammonia level at admission predicts in-hospital mortality for patients with alcoholic hepatitis Gastroenterology Report, 5(3), 2017, 232 236 doi: 10.1093/gastro/gow010 Advance Access Publication Date: 1 May 2016 Original article ORIGINAL ARTICLE Ammonia level at admission predicts in-hospital mortality

More information

Waitlist Priority for Hepatocellular Carcinoma Beyond Milan Criteria: A Potentially Appropriate Decision Without a Structured Approach

Waitlist Priority for Hepatocellular Carcinoma Beyond Milan Criteria: A Potentially Appropriate Decision Without a Structured Approach American Journal of Transplantation 2014; 14: 79 87 Wiley Periodicals Inc. C Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/ajt.12530

More information

Effects of Allocating Livers for Transplantation Based on Model for End-stage Liver Disease-Sodium Scores on Patient Outcomes

Effects of Allocating Livers for Transplantation Based on Model for End-stage Liver Disease-Sodium Scores on Patient Outcomes Accepted Manuscript Effects of Allocating Livers for Transplantation Based on Model for End-stage Liver Disease-Sodium Scores on Patient Outcomes Shunji Nagai, MD, PhD, Lucy C Chau, HBSc, MMI, Randolph

More information

UK Liver Transplant Audit

UK Liver Transplant Audit November 2012 UK Liver Transplant Audit In patients who received a Liver Transplant between 1 st March 1994 and 31 st March 2012 ANNUAL REPORT Advisory Group for National Specialised Services Prepared

More information

For the past two decades, the number of patients

For the past two decades, the number of patients When Shouldn t We Retransplant? Michael A. Zimmerman and R. Mark Ghobrial Key Points 1. In the setting of early graft failure after primary transplantation, orthotopic liver retransplantation (re-olt)

More information

Alcoholic hepatitis (AH) is an acute, inflammatory. MELD Accurately Predicts Mortality in Patients With Alcoholic Hepatitis

Alcoholic hepatitis (AH) is an acute, inflammatory. MELD Accurately Predicts Mortality in Patients With Alcoholic Hepatitis MELD Accurately Predicts Mortality in Patients With Alcoholic Hepatitis Winston Dunn, 1 Laith H. Jamil, 1 Larry S. Brown, 2 Russell H. Wiesner, 1 W. Ray Kim, 1 K. V. Narayanan Menon, 1 Michael Malinchoc,

More information

The evolution in the prioritization for liver transplantation

The evolution in the prioritization for liver transplantation REVIEW Annals of Gastroenterology (2012) 25, 6-13 The evolution in the prioritization for liver transplantation Evangelos Cholongitas a,b, Andrew K. Burroughs b Hippokration General Hospital of Thessaloniki,

More information

Differential Simultaneous Liver and Kidney Transplant Benefit Based on Severity of Liver Damage at the Time of Transplantation

Differential Simultaneous Liver and Kidney Transplant Benefit Based on Severity of Liver Damage at the Time of Transplantation Differential Simultaneous Liver and Kidney Transplant Benefit Based on Severity of Liver Damage at the Time of Transplantation Item Type Article Authors Habib, Shahid; Khan, Khalid; Hsu, Chiu-Hsieh; Meister,

More information

Developing a Kidney Waiting List Calculator

Developing a Kidney Waiting List Calculator Developing a Kidney Waiting List Calculator Jon J. Snyder, PhD* Nicholas Salkowski, PhD, Jiannong Liu, PhD, Kenneth Lamb, PhD, Bryn Thompson, MPH, Ajay Israni, MD, MS, and Bertram Kasiske, MD, FACP *Presenter

More information

Scores in kidney transplantation: How can we use them?

Scores in kidney transplantation: How can we use them? Scores in kidney transplantation: How can we use them? Actualités Néphrologiques 2017 M Hazzan (Lille France ) Contents Scores to estimate the quality of the graft Scores to estimate old candidates to

More information

Liver grafts for transplantation from donors with diabetes: an analysis of the Scientific Registry of Transplant Recipients database

Liver grafts for transplantation from donors with diabetes: an analysis of the Scientific Registry of Transplant Recipients database Title Liver grafts for transplantation from donors with diabetes: an analysis of the Scientific Registry of Transplant Recipients database Author(s) Zheng, J; Xiang, J; Zhou, J; Li, Z; Hu, Z; Lo, CM; Wang,

More information

Organ donation and transplantation trends in the United States, 2001

Organ donation and transplantation trends in the United States, 2001 American Journal of Transplantation 2003; 3 (Suppl. 4): 7 12 Blackwell Munksgaard 2003 Blackwell Munksgaard ISSN 1601-2577 Organ donation and transplantation trends in the United States, 2001 Friedrich

More information

An assessment of different scoring systems in cirrhotic patients undergoing nontransplant surgery

An assessment of different scoring systems in cirrhotic patients undergoing nontransplant surgery The American Journal of Surgery (2012) 203, 589 593 North Pacific Surgical Association An assessment of different scoring systems in cirrhotic patients undergoing nontransplant surgery Marlin Wayne Causey,

More information

Quantification of the Early Risk of Death in Elderly Kidney Transplant Recipients

Quantification of the Early Risk of Death in Elderly Kidney Transplant Recipients Wiley Periodicals Inc. C Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons Quantification of the Early Risk of Death in Elderly Kidney Transplant Recipients

More information

Portal Vein Thrombosis and Outcomes for Pediatric Liver Transplant Candidates and Recipients in the United States

Portal Vein Thrombosis and Outcomes for Pediatric Liver Transplant Candidates and Recipients in the United States LIVER TRANSPLANTATION 17:1066-1072, 2011 ORIGINAL ARTICLE Portal Vein Thrombosis and Outcomes for Pediatric Liver Transplant Candidates and Recipients in the United States Seth A. Waits, 1 Brandon M. Wojcik,

More information

Pre-transplant MELD and sodium MELD scores are poor predictors of graft failure and mortality after liver transplantation

Pre-transplant MELD and sodium MELD scores are poor predictors of graft failure and mortality after liver transplantation Hepatol Int (2011) 5:841 849 DOI 10.1007/s12072-011-9257-z ORIGINAL ARTICLE Pre-transplant MELD and sodium MELD scores are poor predictors of graft failure and mortality after liver transplantation Jacek

More information

Assessment of reproducibility of creatinine measurement and MELD scoring in four liver transplant units in the UK

Assessment of reproducibility of creatinine measurement and MELD scoring in four liver transplant units in the UK Nephrol Dial Transplant (2010) 25: 960 966 doi: 10.1093/ndt/gfp556 Advance Access publication 5 November 2009 Assessment of reproducibility of creatinine measurement and MELD scoring in four liver transplant

More information

T here is an increasing discrepancy between the number of

T here is an increasing discrepancy between the number of 134 LIVER DISEASE MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study F Botta, E Giannini, P Romagnoli,

More information

Predicting Outcome After Cardiac Surgery in Patients With Cirrhosis: A Comparison of Child Pugh and MELD Scores

Predicting Outcome After Cardiac Surgery in Patients With Cirrhosis: A Comparison of Child Pugh and MELD Scores CLINICAL GASTROENTEROLOGY AND HEPATOLOGY 2004;2:719 723 Predicting Outcome After Cardiac Surgery in Patients With Cirrhosis: A Comparison of Child Pugh and MELD Scores AMITABH SUMAN,* DAVID S. BARNES,*

More information

Kidney, Pancreas and Liver Allocation and Distribution

Kidney, Pancreas and Liver Allocation and Distribution American Journal of Transplantation 2012; 12: 3191 3212 Wiley Periodicals Inc. Special Article C Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons doi:

More information

The Art and Science of Increasing Authorization to Donation

The Art and Science of Increasing Authorization to Donation The Art and Science of Increasing Authorization to Donation OPO Metrics: The Good, The Bad, and The Maybe Charlotte Arrington, MPH Arbor Research Collaborative for Health Alan Leichtman, MD University

More information

Pilot Test of a Patient Decision Aid About Liver Transplant Organ Quality

Pilot Test of a Patient Decision Aid About Liver Transplant Organ Quality LIVER TRANSPLANTATION 20:850 855, 2014 ORIGINAL ARTICLE Pilot Test of a Patient Decision Aid About Liver Transplant Organ Quality Michael L. Volk, 1,2 Meghan Roney, 2 and Angela Fagerlin 2,3,4,5 1 Division

More information

Research Article New Onset Diabetes Mellitus in Living Donor versus Deceased Donor Liver Transplant Recipients: Analysis of the UNOS/OPTN Database

Research Article New Onset Diabetes Mellitus in Living Donor versus Deceased Donor Liver Transplant Recipients: Analysis of the UNOS/OPTN Database Transplantation Volume 2013, Article ID 269096, 7 pages http://dx.doi.org/10.1155/2013/269096 Research Article New Onset Diabetes Mellitus in Living Donor versus Deceased Donor Liver Transplant Recipients:

More information

COMPARISON OF THE SURVIVAL OF SHIPPED AND LOCALLY TRANSPLANTED CADAVERIC RENAL ALLOGRAFTS

COMPARISON OF THE SURVIVAL OF SHIPPED AND LOCALLY TRANSPLANTED CADAVERIC RENAL ALLOGRAFTS COMPARISON OF THE SURVIVAL OF SHIPPED AND LOCALLY TRANSPLANTED CADAVERIC RENAL ALLOGRAFTS A COMPARISON OF THE SURVIVAL OF SHIPPED AND LOCALLY TRANSPLANTED CADAVERIC RENAL ALLOGRAFTS KEVIN C. MANGE, M.D.,

More information

Transplant Center Quality Assessment Using a Continuously Updatable, Risk-Adjusted Technique (CUSUM)

Transplant Center Quality Assessment Using a Continuously Updatable, Risk-Adjusted Technique (CUSUM) American Journal of Transplantation 2006; 6: 313 323 Blackwell Munksgaard C 2005 The Authors Journal compilation C 2006 The American Society of Transplantation and the American Society of Transplant Surgeons

More information

Chapter 6: Transplantation

Chapter 6: Transplantation Chapter 6: Transplantation Introduction During calendar year 2012, 17,305 kidney transplants, including kidney-alone and kidney plus at least one additional organ, were performed in the United States.

More information

Predicted Lifetimes for Adult and Pediatric Split Liver Versus Adult Whole Liver Transplant Recipients

Predicted Lifetimes for Adult and Pediatric Split Liver Versus Adult Whole Liver Transplant Recipients American Journal of Transplantation 2004; 4: 1792 1797 Blackwell Munksgaard Copyright C Blackwell Munksgaard 2004 doi: 10.1111/j.1600-6143.2004.00594.x Predicted Lifetimes for Adult and Pediatric Split

More information

ORIGINAL ARTICLE. Received April 30, 2007; accepted June

ORIGINAL ARTICLE. Received April 30, 2007; accepted June LIVER TRANSPLANTATION 13:1405-1413, 2007 ORIGINAL ARTICLE Human Leukocyte Antigen and Adult Living- Donor Liver Transplantation Outcomes: An Analysis of the Organ Procurement and Transplantation Network

More information

Hepatitis C: Difficult-to-treat Patients 11th Paris Hepatology Conference 16th January 2018 Stefan Zeuzem, MD University Hospital, Frankfurt, Germany

Hepatitis C: Difficult-to-treat Patients 11th Paris Hepatology Conference 16th January 2018 Stefan Zeuzem, MD University Hospital, Frankfurt, Germany Hepatitis C: Difficult-to-treat Patients 11th Paris Hepatology Conference 16th January 2018 Stefan Zeuzem, MD University Hospital, Frankfurt, Germany PHC 2018 - www.aphc.info Disclosures Advisory boards:

More information

Evaluation of Renal Profile in Liver Cirrhosis Patients: A Clinical Study

Evaluation of Renal Profile in Liver Cirrhosis Patients: A Clinical Study Original article: Evaluation of Renal Profile in Liver Cirrhosis Patients: A Clinical Study Mukesh Agarwal Assistant Professor, Department of General Medicine, Teerthanker Mahaveer Medical College & Research

More information

Combined Effect of Donor and Recipient Risk on Outcome After Liver Transplantation: Research of the Eurotransplant Database

Combined Effect of Donor and Recipient Risk on Outcome After Liver Transplantation: Research of the Eurotransplant Database LIVER TRANSPLANTATION 21:1486 1493, 2015 ORIGINAL ARTICLE Combined Effect of Donor and Recipient Risk on Outcome After Liver Transplantation: Research of the Eurotransplant Database Joris J. Blok, 1 Hein

More information

Journal of the American College of Cardiology Vol. 60, No. 1, by the American College of Cardiology Foundation ISSN /$36.

Journal of the American College of Cardiology Vol. 60, No. 1, by the American College of Cardiology Foundation ISSN /$36. Journal of the American College of Cardiology Vol. 60, No. 1, 2012 2012 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2012.02.031

More information

OHSU Digital Commons. Oregon Health & Science University. Barry Schlansky. Scholar Archive. July 2013

OHSU Digital Commons. Oregon Health & Science University. Barry Schlansky. Scholar Archive. July 2013 Oregon Health & Science University OHSU Digital Commons Scholar Archive July 2013 Waitlist time predicts survival after liver transplantation for hepatocellular carcinoma : a cohort study in the United

More information

KIDNEY TRANSPLANTATION IS THE

KIDNEY TRANSPLANTATION IS THE ORIGINAL CONTRIBUTION Deceased-Donor Characteristics and the Survival Benefit of Kidney Transplantation Robert M. Merion, MD Valarie B. Ashby, MA Robert A. Wolfe, PhD Dale A. Distant, MD Tempie E. Hulbert-Shearon,

More information

Repeat Organ Transplantation in the United States,

Repeat Organ Transplantation in the United States, American Journal of Transplantation 2007; 7 (Part 2): 1424 1433 Blackwell Munksgaard No claim to original US government works Journal compilation C 2007 The American Society of Transplantation and the

More information

Impact of MELD score implementation on liver allocation: experience at a Brazilian center

Impact of MELD score implementation on liver allocation: experience at a Brazilian center 440 ORIGINAL ARTICLE Gonçalves da Silva Machado A, et al., 2013; 12 (3): 440-447 May-June, Vol. 12 No.3, 2013: 440-447 Impact of MELD score implementation on liver allocation: experience at a Brazilian

More information

From the 1 Department of Transplantation, Mayo Clinic, Jacksonville, FL; 2 Baylor Regional Transplant Institute, Dallas, TX; 3 Division of

From the 1 Department of Transplantation, Mayo Clinic, Jacksonville, FL; 2 Baylor Regional Transplant Institute, Dallas, TX; 3 Division of Estimation of Glomerular Filtration Rates Before and After Orthotopic Liver Transplantation: Evaluation of Current Equations Thomas A. Gonwa, 1 Linda Jennings, 2 Martin L. Mai, 1 Paul C. Stark, 3 Andrew

More information

Diabetes, Hypertension and Hyperlipidemia: Prevalence Over Time and Impact on Long-Term Survival After Liver Transplantation

Diabetes, Hypertension and Hyperlipidemia: Prevalence Over Time and Impact on Long-Term Survival After Liver Transplantation American Journal of Transplantation 2012; 12: 2181 2187 Wiley Periodicals Inc. C Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/j.1600-6143.2012.04077.x

More information

Severity and Mortality Prediction in Chronic Liver Disease using Child PUGH and MELD scales

Severity and Mortality Prediction in Chronic Liver Disease using Child PUGH and MELD scales International Journal of Advanced Biotechnology and Research (IJABR) ISSN 0976-2612, Online ISSN 2278 599X, Vol-10, Issue-1, 2019, pp519-524 http://www.bipublication.com Research Article Severity and Mortality

More information

Transplant Nephrology Update: Focus on Outcomes and Increasing Access to Transplantation

Transplant Nephrology Update: Focus on Outcomes and Increasing Access to Transplantation Transplant Nephrology Update: Focus on Outcomes and Increasing Access to Transplantation Titte R Srinivas, MD, FAST Medical Director, Kidney and Pancreas Transplant Programs Objectives: Describe trends

More information

OPTN/SRTR 2016 Annual Data Report: Preface

OPTN/SRTR 2016 Annual Data Report: Preface OPTN/SRTR 2016 Annual Data Report: Preface This Annual Data Report of the US Organ Procurement and Transplantation Network (OPTN) and the Scientific Registry of Transplant Recipients (SRTR) is the twenty-sixth

More information

The decision to perform combined kidney/liver

The decision to perform combined kidney/liver ORIGINAL ARTICLES Renal Function after Orthotopic Liver Transplantation is Predicted by Duration of Pretransplantation Creatinine Elevation Mical S. Campbell, 1 David S. Kotlyar, 2 Colleen M. Brensinger,

More information

Trends in Organ Donation and Transplantation in the United States,

Trends in Organ Donation and Transplantation in the United States, American Journal of Transplantation 2010; 10 (Part 2): 961 972 Wiley Periodicals Inc. Special Feature No claim to original US government works Journal compilation C 2010 The American Society of Transplantation

More information

Since the beginning of 2002, the priority of adult. Pretransplant MELD Score and Post Liver Transplantation Survival in the UK and Ireland

Since the beginning of 2002, the priority of adult. Pretransplant MELD Score and Post Liver Transplantation Survival in the UK and Ireland Pretransplant MELD Score and Post Liver Transplantation Survival in the UK and Ireland Mathew Jacob, 1 Lynn P. Copley, 1 James D. Lewsey, 1,2 Alex Gimson, 3 Giles J. Toogood, 4 Mohamed Rela, 5 and Jan

More information

Review Article Experience Since MELD Implementation: How Does the New System Deliver?

Review Article Experience Since MELD Implementation: How Does the New System Deliver? International Hepatology Volume 2012, Article ID 264015, 5 pages doi:10.1155/2012/264015 Review Article Experience Since MELD Implementation: How Does the New System Deliver? Markus Quante, Christoph Benckert,

More information

See Editorial, pages

See Editorial, pages Journal of Hepatology 42 (2005) 826 832 www.elsevier.com/locate/jhep Evaluation of the increase in model for end-stage liver disease (DMELD) score over time as a prognostic predictor in patients with advanced

More information

Underutilization of Living Donor Liver Transplantation in the United States: Bias against MELD 20 and Higher

Underutilization of Living Donor Liver Transplantation in the United States: Bias against MELD 20 and Higher Original Article Underutilization of Living Donor Liver Transplantation in the United States: Bias against MELD 20 and Higher Ryan B. Perumpail 1, Eric R. Yoo 2, George Cholankeril 3, Lupe Hogan 1, Melodie

More information

Disparities in Liver Transplant Allocation: An Update on MELD Allocation System

Disparities in Liver Transplant Allocation: An Update on MELD Allocation System Disparities in Liver Transplant Allocation: An Update on MELD Allocation System Naudia L. Jonassaint, MD MHS Assistant Professor of Medicine and Surgery University of Pittsburgh School of Medicine Historical

More information

. Time to transplant listing is dependent on. . In 2003, 9.1% of all prevalent transplant. . Patients with diabetes mellitus are less

. Time to transplant listing is dependent on. . In 2003, 9.1% of all prevalent transplant. . Patients with diabetes mellitus are less Chapter 5: Joint Analyses with UK Transplant in England and Wales; Access to the Renal Transplant Waiting List, Time to Listing, Diabetic Access to Transplantation and the Influence of Social Deprivation

More information

Average number of transplants per calendar year performed at UAMS

Average number of transplants per calendar year performed at UAMS Summary clinical service 1. Liver transplant program: The UAMS liver transplant program has been open since May 2005. The program performed 180 transplants during its first 7 years and 5 months of existence.

More information

New Organ Allocation Policy in Liver Transplantation in the United States

New Organ Allocation Policy in Liver Transplantation in the United States REVIEW New Organ Allocation Policy in Liver Transplantation in the United States David A. Goldberg, M.D., M.S.C.E.,*,, Richard Gilroy, and Michael Charlton, MD., F.R.C.P. The number of potential recipients

More information

Obesity is perhaps the most significant public health problem

Obesity is perhaps the most significant public health problem Obesity and Its Effect on Survival in Patients Undergoing Orthotopic Liver Transplantation in the United States Satheesh Nair, 1 Sumita Verma, 2 and Paul J. Thuluvath 2 Studies assessing morbidity and

More information

Current status of kidney and pancreas transplantation in the United States,

Current status of kidney and pancreas transplantation in the United States, American Journal of Transplantation 25; 5 (Part 2): 94 915 Blackwell Munksgaard Blackwell Munksgaard 25 Current status of kidney and pancreas transplantation in the United States, 1994 23 Gabriel M. Danovitch

More information

Allocation of deceased donor kidneys. Phil Clayton NSW Renal Group 14 June 2012

Allocation of deceased donor kidneys. Phil Clayton NSW Renal Group 14 June 2012 Allocation of deceased donor kidneys Phil Clayton NSW Renal Group 14 June 2012 Outline Why study kidney allocation? Equity vs utility Current Australian model Previous work in Australia US allocation research

More information

Association of Center Volume with Outcome After Liver and Kidney Transplantation

Association of Center Volume with Outcome After Liver and Kidney Transplantation American Journal of Transplantation 2004; 4: 920 927 Blackwell Munksgaard Copyright C Blackwell Munksgaard 2004 doi: 10.1111/j.1600-6143.2004.00462.x Association of Center Volume with Outcome After Liver

More information

Comparing Living Donor and Deceased Donor Liver Transplantation: A Matched National Analysis From 2007 to 2012

Comparing Living Donor and Deceased Donor Liver Transplantation: A Matched National Analysis From 2007 to 2012 LIVER TRANSPLANTATION 20:1347 1355, 2014 ORIGINAL ARTICLE Comparing Living Donor and Deceased Donor Liver Transplantation: A Matched National Analysis From 2007 to 2012 Richard S. Hoehn, 1 Gregory C. Wilson,

More information

Final Report: Update on Prior Living Donors Who Were Subsequently Placed on the Waiting List

Final Report: Update on Prior Living Donors Who Were Subsequently Placed on the Waiting List OPTN/UNOS Minority Affairs Committee Descriptive Data Request Final Report: Update on Prior Living Donors Who Were Subsequently Placed on the Waiting List Prepared for: Minority Affairs Committee Meeting

More information

Update on Kidney Allocation

Update on Kidney Allocation Update on Kidney Allocation 23rd Annual Conference Association for Multicultural Affairs in Transplantation Silas P. Norman, M.D., M.P.H. Associate Professor Division of Nephrology September 23, 2015 Disclosures

More information

Autoimmune Hepatitis: Defining the need for Liver Transplantation

Autoimmune Hepatitis: Defining the need for Liver Transplantation Autoimmune Hepatitis: Defining the need for Liver Transplantation Michael A Heneghan, MD, MMedSc, FRCPI. Institute of Liver Studies, King s College Hospital, London Outline Autoimmune Hepatitis Background

More information

Pancreas After Islet Transplantation: A First Report of the International Pancreas Transplant Registry

Pancreas After Islet Transplantation: A First Report of the International Pancreas Transplant Registry American Journal of Transplantation 2016; 16: 688 693 Wiley Periodicals Inc. Brief Communication Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons doi:

More information