RE: Breaking News From The AASLD

November 4, 2008

Why can't they give some numbers that are easy to understand?? Like with a MELD of 14 when transplanted their life expectancy is X years, and with a MELD of 11 when transplanted their life expectancy is Y years.

Ian (52) PSC 89

AASLD 2008: Mortality Lower for Early Liver Transplant in Healthier Patients

Patients with low to mid Model for End-Stage Liver Disease (MELD) scores benefit more from early liver transplantation than sicker patients, said Goldstein, MD, from Columbia University, in New York City, here at The Liver Meeting 2008, the 59th Annual Meeting of the American Association for the Study of Liver Diseases.

Dr. Goldstein and his colleagues looked at the 5-year survival rate from the time patients were put on the waitlist, analyzing United Network for Organ Sharing (UNOS) data from a 2002 to 2006 study of 22,863 liver-only adult transplant recipients and 43,497 liver transplant waitlist patients. They looked at both waitlist and post-transplant mortality. The organ transplants studied included both living-donor organs and deceased donor high-donor-risk index organs and low-donor-risk index organs.

Early timing of liver transplants was key to the analysis. Dr. Goldstein calculated a " break even " 5-year mortality rate for high- and low-risk organs to find the best timing for high DRI organ transplantation. For example, for patients with a MELD score of 11 to 14, survival improved with transplantation at 15 months instead of a projected 21 months, he stated in his presentation.

He also said during his presentation that living-donor allografts worked well for patients with MELD scores lower than 15. Dr. Goldstein said that " living donor allografts actually outperformed all deceased-donor allografts, " in the UNOS data.

In the 4 MELD-score cohorts (<10, 11–18, 19–24, and >25), those with the lowest and highest MELD scores who received an early living-donor transplant had 5-year mortality rates higher than the national average: those with a MELD score lower than 10 had a 3.5% increased mortality rate, and those with a MELD score higher than 25 had a 7.6% increased mortality rate. However, 5-year mortality decreased for early living-donor transplants given to patients with MELD scores of 11 to 18 (a 13.4% decrease) and of 19 to 24 (a 14.8% decrease).

Patients who received a high DRI organ followed a similar pattern. Those with a MELD score higher than 25 had a slight improvement in 5-year mortality rates, but those with MELD scores in the middle 2 cohorts (11 to 18 and 19 to 24) benefited most.

Dr. Goldstein admitted that his conclusions are " somewhat contradictory to the general MELD principles " of treating the sickest patients first, since the patients he recommends for early transplant are " exactly those patients who no one transplants early, " he told Medscape Gastroenterology. However, he said that patients with lower MELD scores " have the most to gain " because they have a better quality of life before and after transplantation and live longer post-transplant than the sicker patients. When making transplantation decisions with limited organs, " we should look at the total benefit for society as a whole, " he said.

http://www.medscape.com/viewarticle/582920?sssdmh=dm1.400275 & src=nlconfnews & spon=20 & uac=12920HV

Barb in Texas - Together in the Fight - Whatever it Takes!

Son Ken (34) UC 91 PSC 99, LTX 6/21 & 6/30 2007 @ Baylor/Dallas

-- Ian Cribb P.Eng.

November 4, 2008