Is Liver Transplant Justified at Any MELD Score?

作者：Hannah Oden-Brunson, Malcolm F. McDonald, Elizabeth L. Godfrey, Stephanie S. Keeling, George Cholankeril, Fasiha Kanwal, Christine A. O’Mahony, John A. Goss, Abbas Rana · 发表于：Transplantation · 年份：2022 · DOI：10.1097/tp.0000000000004345 · 被引用次数：11 · 研究领域：Liver Disease and Transplantation、Organ Transplantation Techniques and Outcomes、Renal Transplantation Outcomes and Treatments

BACKGROUND: Assessing the survival benefit of transplantation in patients with end-stage liver disease is critical in guiding the decision-making process for liver allocation. Previous studies established increased mortality risk for those transplanted below Model for End-Stage Liver Disease (MELD) 18 compared with candidates who remained on the waitlist; however, improved outcomes of liver transplantation and a changing landscape in the donor supply warrant re-evaluation of this idea. METHODS: Using the United Network for Organ Sharing database, we analyzed 160 290 candidates who were waitlisted for liver transplantation within MELD cohorts. We compared patients who were transplanted in a MELD cohort with those listed but not transplanted in that listed MELD cohort with an intent-to-treat analysis. RESULTS: Those transplanted at a MELD between 6 and 11 showed a 31% reduction in adjusted mortality (HR = 0.69 [95% confidence interval [CI], 0.66-0.75]; P < 0.001) compared with the intent-to-treat cohort in a Cox multivariate regression. This mortality benefit increased to a 37% adjusted reduction for those transplanted at MELD between 12 and 14 (HR = 0.63 [95% CI, 0.60-0.66]; P < 0.001) and a 46% adjusted reduction for those transplanted at a MELD between 15 and 17 (HR = 0.54 [95% CI, 0.52-0.57]; P < 0.001), effects that remained in sensitivity analyses excluding patients with hepatocellular carcinoma, encephalopathy, ascites, and variceal bleeds. A multivariate analysis of pat...