The MELD upgrade exception: a successful strategy to optimize access to liver transplantation for patients with high waiting list mortality.

Dirchwolf, M.; Becchetti, C.; Gschwend, S.G.; Toso, C.; Dutkowski, P.; Immer, F.; Beyeler, F.; Rossi, S.; Schropp, J.; Dufour, J.F.; Banz, V.

doi:10.1016/j.hpb.2021.12.009

The MELD upgrade exception: a successful strategy to optimize access to liver transplantation for patients with high waiting list mortality.

Détails

Demande d'une copie Sous embargo indéterminé.
Accès restreint UNIL
Etat: Public
Version: Final published version
Licence: Tous droits réservés

ID Serval

serval:BIB_63DBC81F8439

Type

Article: article d'un périodique ou d'un magazine.

Collection

Publications

Institution

UNIL/CHUV

Titre

The MELD upgrade exception: a successful strategy to optimize access to liver transplantation for patients with high waiting list mortality.

Périodique

HPB

Auteur⸱e⸱s

Dirchwolf M., Becchetti C., Gschwend S.G., Toso C., Dutkowski P., Immer F., Beyeler F., Rossi S., Schropp J., Dufour J.F., Banz V.

Collaborateur⸱rice⸱s

Swiss Transplant Cohort Study

Contributeur⸱rice⸱s

Amico P., Axel A., Aubert J.D., Banz V., Sonja B., Beldi G., Benden C., Berger C., Binet I., Bochud P.Y., Branca S., Bucher H., Carrel T., Catana E., Chalandon Y., de Geest S., de Rougemont O., Dickenmann M., Dreifuss J.L., Duchosal M., Fehr T., Ferrari-Lacraz S., Garzoni C., Soccal P.G., Gaudet C., Giostra E., Golshayan D., Hadaya K., Halter J., Hauri D., Heim D., Hess C., Hillinger S., Hirsch H., Hirt P., Hofbauer G., Huynh-Do U., Immer F., Koller M., Laesser B., Lang B., Lehmann R., Leichtle A., Lovis C., Manuel O., Marti H.P., Martin P.Y., Martinelli M., Mellac K., Merçay A., Mettler K., Meylan P., Mueller N., Müller A., Müller T., Müller-Arndt U., Müllhaupt B., Nägeli M., Pascual M., Posfay-Barbe K., Rick J., Rosselet A., Rossi S., Rothlin S., Ruschitzka F., Schanz U., Schaub S., Schnyder A., Schuurmans M., Simonetta F., Staufer K., Stampf S., Steiger J., Stirniman G., Stürzinger U., Toso C., Van Delden C., Venetz J.P., Villard J., Vionnet J., Wick M., Wilhlem M., Yerly P.

ISSN

1477-2574 (Electronic)

ISSN-L

1365-182X

Statut éditorial

Publié

Date de publication

07/2022

Peer-reviewed

Oui

Volume

Numéro

Pages

1168-1176

Langue

anglais

Notes

Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish

Résumé

MELD exceptions are designed to equipoise liver transplant waiting list survival. We aimed to analyze the impact of the MELD Upgrade rule and all other MELD exceptions on the liver transplant waiting list outcomes during 2012-2017 in Switzerland.
We conducted a nationwide cohort study including all adult patients registered on the Swiss liver transplant waiting list between 2012 and 2017. Waiting list mortality and access to transplantation were analyzed, considering MELD exceptions as time-dependent covariates.
730 patients were included. Patients with MELD Upgrade exceptions had a higher risk of dying while on the waiting list (OR 2.13; CI 95% 1.30-3.47) and also an increased likelihood of receiving a liver transplantation, when compared to patients without MELD exceptions. Patients with any type of MELD exceptions were more likely to be transplanted when compared to patients without MELD exceptions. The proportion of patients with MELD exceptions increased from 2012 to 2017 (44% vs 88%). Allocation MELD at the time of transplantation showed an annual increase (23 ± 8 points vs 32 ± 5 points, p < 0.001).
Only patients with MELD Upgrade exceptions had the expected combination of higher waiting list mortality and quicker access to liver transplantation.

Mots-clé

Adult, Cohort Studies, Humans, Liver Transplantation/adverse effects, Severity of Illness Index, Switzerland, Waiting Lists

OAI-PMH

oai:serval.unil.ch:BIB_63DBC81F8439

DOI

10.1016/j.hpb.2021.12.009

Pubmed

35065891

Web of science

000822922100020

Création de la notice

26/01/2024 13:07