Fw: [TRNSPLNT] 9.05.2008

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Subject: [TRNSPLNT] 9.05.2008To: TRNSPLNT@...Date: Friday, September 5, 2008, 11:08 AM9.05.2008

Adjusting Scoring System for Liver Transplant Could make System more

Equitable

Scoring fix urged for liver patients

By Fabregas

Friday, September 5, 2008

Some patients at the bottom of liver transplant waiting lists could

get organs faster with a modest change to the scoring system that

prioritizes patients on the lists, according to research published

Thursday in the New England Journal of Medicine.

The system, which ranks patients based on three factors, could be

improved by adding a fourth test that measures levels of serum sodium

-- an indicator of severe sickness in a key group of liver patients,

the researchers from Mayo Clinic reported.

"The data pretty strongly indicates that this could save lives," said

Dr. W. Ray Kim, the study's lead author and a hepatologist at Mayo

Clinic's campus in Rochester, Minn.

Altering the allocation system known as MELD, which stands for Model

for End Stage Liver Disease, was one of several options proposed by

experts after a Tribune-Review investigation this year that showed

some patients get liver transplants when they don't need them.

The three-day series showed patients at the lower end of the MELD

scale -- ranging from 6 for the least ill to 40 for those at greater

risk of death -- often get transplants when they could have lived

longer without them.

Doctors have specifically advocated tweaking the MELD score by adding

the serum sodium test, a factor that is being examined by the United

Network for Organ Sharing, the federal agency that manages the organ

allocation system.

"We are aware of the value of sodium," said Dr. Washburn, co-

chairman of the UNOS liver committee and a transplant surgeon at the

University of Texas Health Science Center.

The UNOS committee, emboldened by the Trib series, has been working to

improve the liver allocation system at a time when more than 16,000

patients are on the waiting list. In July, the committee voted to move

forward a proposal to implement a wider, regional sharing plan. It

would make livers available first to the sickest patients within a

wider geographic area rather than local delineations.

But even if given final approval, that system would use the 6-year-old

MELD system, which ranks patients based on three blood tests that do

not include serum sodium.

The serum sodium test has been particularly effective in predicting

death among patients with cirrhosis, a chronic illness that causes

scar tissue to build in the liver, Kim said.

Low levels of serum sodium indicate severe illness in some patients

who would otherwise have low MELD scores. Those patients almost always

are afflicted by a condition known as ascites, in which fluid builds

up in the abdomen. Nonetheless, they get stuck at the bottom of

waiting lists, Kim said.

The Mayo Clinic researchers created a statistical model using 2005

data provided by UNOS. Using the model, researchers analyzed data from

2006, when 477 patients died within three months of being listed for a

liver transplant.

Using the serum sodium factor showed that 7 percent of those patients

would have received higher priority for a transplant, perhaps

preventing their deaths.

source: (Pittsburgh Tribune-Review)

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