AASLD: New Approach Urged for Liver Transplant Allocation

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http://www.medpagetoday.com/MeetingCoverage/AASLD/11576

Medical News from

AASLD: American Association for the Study of Liver Diseases Meeting

AASLD: New Approach Urged for Liver Transplant Allocation

By , North American Correspondent, MedPage Today

Published: November 03, 2008

Reviewed by Jasmer, MD; Associate Clinical Professor of Medicine,

University of California, San Francisco Earn CME/CE credit

for reading medical news

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SAN FRANCISCO, Nov. 3 -- Dying liver-transplant candidates with a poor risk for

long-term survival should not be moved ahead on the waiting list of those with

better prospects, a surgeon proposed here.

Recommending a radical shift in priority to emphasize the greatest good for the

scarce organs, Goldstein, M.D., of Columbia, pointed out that the

current allocation system gives liver transplants disproportionately to those at

a poor risk for lengthy survival.

Instead, he said at the American Association for the Study of Liver Diseases

meeting here, the priority should be changed from sicker-first patients to those

most likely to have a long-term survival.

" We need to prioritize patients that may potentially have the best benefit for

survival, " he added.

Currently, livers for transplant are allocated using the Model for End-Stage

Liver Disease (MELD) score, with those having higher scores placed higher on the

list for the scarce organs, said Dr. Goldstein. " We need to prioritize patients

that may potentially have the best benefit for survival. " Action Points

--------------------------------------------------------------------------------

Explain to interested patients that livers for transplant are currently

allocated on the basis of Model for End-Stage Liver Disease (MELD) score, based

on three prognostic factors for mortality.

Note that this analysis found that longer survival is possible if patients are

transplanted earlier than their MELD scores would suggest

Note that this study was published as an abstract and presented orally at a

conference. These data and conclusions should be considered to be preliminary

until published in a peer-reviewed journal.

Dr. Goldstein and colleagues have been using such a system for their patients

and -- to see if it was justified -- undertook an analysis of 43,497 wait-listed

patients from March 1, 2002 to Aug. 1, 2006, including 22,863 adult liver-only

transplant recipients.

The information came from the United Network for Organ Sharing, which oversees

the national database of clinical transplant information and operates the

computerized organ sharing system.

The researchers calculated relative wait-list mortality risk by MELD score, as

well as the MELD-dependent post-transplant survival in recipients who received

livers from living donors or low- and high-risk deceased donors.

Over the five years after a transplant, those who got livers from living donors

did significantly better than those who got livers from low- or high-risk

deceased donors, at P=0.001 and P

[Guest guest]

http://www.medpagetoday.com/MeetingCoverage/AASLD/11576

Medical News from

AASLD: American Association for the Study of Liver Diseases Meeting

AASLD: New Approach Urged for Liver Transplant Allocation

By , North American Correspondent, MedPage Today

Published: November 03, 2008

Reviewed by Jasmer, MD; Associate Clinical Professor of Medicine,

University of California, San Francisco Earn CME/CE credit

for reading medical news

Use this code to embed video on your website or blog:

SAN FRANCISCO, Nov. 3 -- Dying liver-transplant candidates with a poor risk for

long-term survival should not be moved ahead on the waiting list of those with

better prospects, a surgeon proposed here.

Recommending a radical shift in priority to emphasize the greatest good for the

scarce organs, Goldstein, M.D., of Columbia, pointed out that the

current allocation system gives liver transplants disproportionately to those at

a poor risk for lengthy survival.

Instead, he said at the American Association for the Study of Liver Diseases

meeting here, the priority should be changed from sicker-first patients to those

most likely to have a long-term survival.

" We need to prioritize patients that may potentially have the best benefit for

survival, " he added.

Currently, livers for transplant are allocated using the Model for End-Stage

Liver Disease (MELD) score, with those having higher scores placed higher on the

list for the scarce organs, said Dr. Goldstein. " We need to prioritize patients

that may potentially have the best benefit for survival. " Action Points

--------------------------------------------------------------------------------

Explain to interested patients that livers for transplant are currently

allocated on the basis of Model for End-Stage Liver Disease (MELD) score, based

on three prognostic factors for mortality.

Note that this analysis found that longer survival is possible if patients are

transplanted earlier than their MELD scores would suggest

Note that this study was published as an abstract and presented orally at a

conference. These data and conclusions should be considered to be preliminary

until published in a peer-reviewed journal.

Dr. Goldstein and colleagues have been using such a system for their patients

and -- to see if it was justified -- undertook an analysis of 43,497 wait-listed

patients from March 1, 2002 to Aug. 1, 2006, including 22,863 adult liver-only

transplant recipients.

The information came from the United Network for Organ Sharing, which oversees

the national database of clinical transplant information and operates the

computerized organ sharing system.

The researchers calculated relative wait-list mortality risk by MELD score, as

well as the MELD-dependent post-transplant survival in recipients who received

livers from living donors or low- and high-risk deceased donors.

Over the five years after a transplant, those who got livers from living donors

did significantly better than those who got livers from low- or high-risk

deceased donors, at P=0.001 and P