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.

Details

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Serval ID

serval:BIB_63DBC81F8439

Type

Article: article from journal or magazin.

Collection

Publications

Institution

UNIL/CHUV

Title

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

Journal

HPB

Author(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.

Working group(s)

Swiss Transplant Cohort Study

Contributor(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

Publication state

Published

Issued date

07/2022

Peer-reviewed

Oui

Volume

Number

Pages

1168-1176

Language

english

Notes

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

Abstract

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.

Keywords

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

Create date

26/01/2024 14:07