Abstract
Patients listed for liver-intestine transplantation suffer higher waiting list mortality than those listed for liver-only, thus leading to policy revisions seeking to close the gap. We sought to determine the impact of key model for end-stage liver disease (MELD)/pediatric end-stage liver disease (PELD) policy modifications on the waiting list mortality of adult and pediatric liver-intestine candidates as compared to liver-only candidates. Analysis of UNOS data separated into adult and pediatric categories and based on time periods of policy implementation revealed higher mortality in liver-intestine candidates over all time periods studied (p < 0.001 pediatric and adult). After implementation of a revision to augment their MELD scores based on a sliding scale, adult liver-intestine candidates with calculated MELD > 15 no longer suffered higher mortality although this change did not completely eliminate the mortality disparity for candidates with MELD < 15 (p < 0.01). The waiting list mortality of pediatric liver-intestine candidates dropped significantly after a revision that gave them 23 additional MELD/PELD points (p < 0.01) although the mortality disparity with pediatric liver-only candidates was not eliminated. Following this revision, mortality in pediatric liver-only and liver-intestine Status 1 candidates was similar, however more liver-intestine candidates were listed as Status 1B. This data demonstrates that a mortality disparity remains for liver-intestine candidates compared with candidates listed for liver-only. Through analysis of OPTN data separated into time periods based on MELD/PELD policy revisions, this study demonstrates a disparity in the waiting list mortality of liver-only and liver-intestine transplantation candidates despite the implementation of policies designed to equalize this gap.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1896-1904 |
| Number of pages | 9 |
| Journal | American Journal of Transplantation |
| Volume | 11 |
| Issue number | 9 |
| DOIs | |
| State | Published - Sep 2011 |
| Externally published | Yes |
Bibliographical note
Funding Information:Financial/nonfinancial disclosures: The authors have reported to CHEST the following: A. B. C. is supported by an Australian National Health and Medical Research Council (NHMRC) practitioner fellowship (grant 1154302 ) and holds multiple grants awarded from the NHMRC related to diseases associated with pediatric cough. The views expressed in this publication are those of the authors and do not reflect the views of the NHMRC. A. B. C. is also an author and reviewer for Up-to-Date; data safety monitoring board member for an unlicensed vaccine study (Glaxo); advisor for study design of an unlicensed product (Merck); has received multiple peer-reviewed competitive grants from the Australian National Health and Medical Research Council. A. B. C. has no financial or intellectual conflicts of interest regarding the content of the manuscript. J. J. O. is on the Board of Directors for the American Board of Allergy and Immunology; an Associate Editor of Annals of Allergy and Allergy Watch ; reviewer for Up-to-Date; performed clinical research for AstraZeneca, Boehringer Ingelheim, Glaxo, Medimmune, and Novartis; member of the Adjudication Committee for AstraZeneca and Novartis; member of the data safety monitoring board for The Ohio State University; and is a consultant for Glaxo, Myelin, Church and Dwight, and Meda. R. S. I. has no financial or intellectual conflicts of interest regarding the content of this manuscript. Moreover, although R. S. I. is the Editor in Chief of CHEST, the review and all editorial decisions regarding the manuscript were independently made by others. None declared (A. K., M. W., B. K. R., P. J. K.).
Keywords
- Intestine
- UNOS policy
- liver
- mortality
- transplant
- waiting list