Background & Aims The current organ allocation system for liver transplantation (LT) creates an imbalance between patients with and without hepatocellular carcinoma (HCC). We describe a model designed to re-establish allocation equity among patient groups using transplant benefit as the common endpoint. Methods We enrolled consecutive adult patients entering the waiting list (WL group, n = 2697) and undergoing LT (LT group, n = 1702) during the period 2004-2009 in the North Italy Transplant program area. Independent multivariable regressions (WL and LT models) were created for patients without HCC and for those with stage T2 HCC. Monte Carlo simulation was used to create distributions of transplant benefit, and covariates such as Model for End-stage Liver Disease (MELD) and alpha-fetoprotein (AFP) were combined in regression equations. These equations were then calibrated to create an "MELD equivalent" which matches HCC patients to non-HCC patients having the same numerical MELD score. Results Median 5 year transplant benefit was 15.12 months (8.75-25.35) for the non-HCC patients, and 28.18 months (15.11-36.38) for the T2-HCC patients (p <0.001). Independent predictors of transplant benefit were MELD score (estimate = 0.89, p <0.001) among non-HCC patients, and MELD (estimate = 1.14, p <0.001) and logAFP (estimate = -0.46, p <0.001) among HCC patients. The equation "HCC-MELD" = 1.27 â̂ - MELD - 0.51 â̂ - logAFP + 4.59 calculates a numerical score for HCC patients, whereby their transplant benefit is equal to that of non-HCC patients with the same numerical value for MELD. Conclusions We describe a method for calibrating HCC and non-HCC patients according to survival benefit, and propose that this method has the potential, if externally validated, to restore equity to the organ allocation system.

A method for establishing allocation equity among patients with and without hepatocellular carcinoma on a common liver transplant waiting list / A. Vitale, M.L. Volk, T.M. De Feo, P. Burra, A.C. Frigo, R. Ramirez Morales, L. De Carlis, L. Belli, M. Colledan, S. Fagiuoli, G. Rossi, E. Andorno, U. Baccarani, E. Regalia, M. Vivarelli, M. Donataccio, U. Cillo. - In: JOURNAL OF HEPATOLOGY. - ISSN 0168-8278. - 60:2(2014), pp. 290-297. [10.1016/j.jhep.2013.10.010]

A method for establishing allocation equity among patients with and without hepatocellular carcinoma on a common liver transplant waiting list

T.M. De Feo;G. Rossi;
2014

Abstract

Background & Aims The current organ allocation system for liver transplantation (LT) creates an imbalance between patients with and without hepatocellular carcinoma (HCC). We describe a model designed to re-establish allocation equity among patient groups using transplant benefit as the common endpoint. Methods We enrolled consecutive adult patients entering the waiting list (WL group, n = 2697) and undergoing LT (LT group, n = 1702) during the period 2004-2009 in the North Italy Transplant program area. Independent multivariable regressions (WL and LT models) were created for patients without HCC and for those with stage T2 HCC. Monte Carlo simulation was used to create distributions of transplant benefit, and covariates such as Model for End-stage Liver Disease (MELD) and alpha-fetoprotein (AFP) were combined in regression equations. These equations were then calibrated to create an "MELD equivalent" which matches HCC patients to non-HCC patients having the same numerical MELD score. Results Median 5 year transplant benefit was 15.12 months (8.75-25.35) for the non-HCC patients, and 28.18 months (15.11-36.38) for the T2-HCC patients (p <0.001). Independent predictors of transplant benefit were MELD score (estimate = 0.89, p <0.001) among non-HCC patients, and MELD (estimate = 1.14, p <0.001) and logAFP (estimate = -0.46, p <0.001) among HCC patients. The equation "HCC-MELD" = 1.27 â̂ - MELD - 0.51 â̂ - logAFP + 4.59 calculates a numerical score for HCC patients, whereby their transplant benefit is equal to that of non-HCC patients with the same numerical value for MELD. Conclusions We describe a method for calibrating HCC and non-HCC patients according to survival benefit, and propose that this method has the potential, if externally validated, to restore equity to the organ allocation system.
Cirrhosis; Clinical decision making; Hepatocellular carcinoma; Liver transplantation; Surgical oncology
Settore MED/18 - Chirurgia Generale
2014
23-ott-2013
Article (author)
File in questo prodotto:
File Dimensione Formato  
A method for establishing allocation equity among patients with and without hepatocellular carcinoma on a common liver transplant waiting list.pdf

accesso riservato

Tipologia: Publisher's version/PDF
Dimensione 973.48 kB
Formato Adobe PDF
973.48 kB Adobe PDF   Visualizza/Apri   Richiedi una copia
Pubblicazioni consigliate

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/335124
Citazioni
  • ???jsp.display-item.citation.pmc??? 27
  • Scopus 87
  • ???jsp.display-item.citation.isi??? 80
social impact