MELD-based graft allocation system fails to improve liver transplantation efficacy in a single-center intent-to-treat analysis - 05/11/12
Corresponding author. Service de chirurgie hépatobiliaire et digestive, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France. Tel.: +33 2 99 28 42 65; fax: +33 2 99 28 41 29.Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
| pages | 9 |
| Iconographies | 3 |
| Vidéos | 0 |
| Autres | 0 |
Summary |
Background |
Since March 2007, priority access to liver transplantation in France has been given to patients with the highest MELD scores.
Objective |
To undertake an intent-to-treat comparison of center-based vs. MELD-based liver graft allocation.
Methods |
Retrospective cohort analysis (patients listed 6th March 2007 to 5th March 2009; MELD period) with a matched historical cohort (patients listed 6th March 2005 to 5th March 2007; pre-MELD period) in a single high-volume center. Analysis was on an intent-to-treat basis, i.e. starting on the day of wait listing.
Results |
Compared to pre-MELD, fewer patients with a MELD score less or equal to 14 (P=0.002), and more patients with a MELD greater or equal to 24 (P<0.05) were transplanted during the MELD period. For HCC candidates, median waiting time increased (121 vs. 54 days, P=0.01), transplantation rate halved (35% vs. 73.5%, P<0.001) and dropouts due to tumor progression increased (16% vs. 0%, P<0.001). Moreover, postoperative course did not change significantly except for infectious complications (35% vs. 24%, P=0.02); overall patient survival was 69.8±3.1% vs. 76±2.9% (P=0.29) and overall graft survival was 77.6±3.4% vs. 82.8±2.9% (P=0.29). Transplant failures were mainly due to deaths on the waiting list in the previous system, but to dropouts related to disease progression in the new system. Cirrhotic patient survival rate did not change (78.1±4.4% vs. 73.5±4.5%, P=0.42), while that of HCC patients decreased (65.3±5.3% vs. 86.8±4.4%, P=0.01). Post-transplant survival worsened significantly according to pre-transplant MELD score (P=0.009).
Conclusion |
The MELD-based graft allocation system introduced discrimination against HCC patients, whose incidence has increased dramatically, and should be reevaluated.
Le texte complet de cet article est disponible en PDF.Abbreviations : HCC, LT, MELD, WL, WT
Plan
Vol 36 - N° 5
P. 464-472 - octobre 2012 Retour au numéro
Article précédent
- Performances of Elasto-FibroTest®, a combination between FibroTest® and liver stiffness measurements for assessing the stage of liver fibrosis in patients with chronic hepatitis C
- Thierry Poynard, Victor de Ledinghen, Jean-Pierre Zarski, Carol Stanciu, Mona Munteanu, Julien Vergniol, Julie France, Anca Trifan, Gilles Lenaour, Jean-Christophe Vaillant, Vlad Ratziu, Frederic Charlotte, the Fibrosis-TAGS group 1
- Aberrant expression of Wnt and Notch signal pathways in Barrett’s esophagus
- Xia Chen, Ke Jiang, Zhining Fan, Zheng Liu, Ping Zhang, Liduan Zheng, Na Peng, Jingjing Tong, Guozhong Ji
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’achat d’article à l’unité est indisponible à l’heure actuelle.
Déjà abonné à cette revue ?