Document Detail


Hepatocellular carcinoma patients are advantaged in the current liver transplant allocation system.
MedLine Citation:
PMID:  20486906     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Patients with hepatocellular carcinoma (HCC) within Milan criteria receive priority on the liver transplant waiting list (WL) and compete with non-HCC patients. Dropout from the WL is an indirect measure of transplant access. Competing risks (CR) evaluation of dropout for HCC and non-HCC patients has not previously been reported. Patients listed between 16 March 2005 and 30 June 2008 were included. Probability of dropout was estimated using a CR technique as well as a Cox model for time to dropout. Overall, non-HCC patients had a higher dropout rate from the WL than HCC patients (p < 0.0001). This was reproducible throughout all regions. In Cox regression, tumor size, model for end-stage liver disease (MELD) score and alpha fetoprotein (AFP) were associated with increased dropout risk. Multivariable analysis with CR showed that MELD score and AFP, were most influential in predicting dropout for HCC patients. The index of concordance for predicting dropout with the CR was 0.70. HCC patients appear to be advantaged in the current allocation scheme based on lower dropout rates without regard to geography. A continuous score incorporating MELD, AFP and tumor size may help to prioritize HCC patients to better equate dropout rates with non-HCC patients and equalize access.
Authors:
K Washburn; E Edwards; A Harper; R Freeman
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.     Date:  2010-05-10
Journal Detail:
Title:  American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons     Volume:  10     ISSN:  1600-6143     ISO Abbreviation:  Am. J. Transplant.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-20     Completed Date:  2010-10-29     Revised Date:  2011-12-02    
Medline Journal Info:
Nlm Unique ID:  100968638     Medline TA:  Am J Transplant     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1643-8     Citation Subset:  IM    
Affiliation:
University of Texas Health Science Center, San Antonio, USA. washburn@uthscsa.edu
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MeSH Terms
Descriptor/Qualifier:
Carcinoma, Hepatocellular / pathology,  surgery*
Health Care Rationing
Humans
Liver Neoplasms / pathology,  surgery*
Liver Transplantation / statistics & numerical data*
Neoplasm Staging
Patient Dropouts / statistics & numerical data
Predictive Value of Tests
Resource Allocation / methods*,  standards
Risk Assessment
Waiting Lists
Grant Support
ID/Acronym/Agency:
234-2005-370011C//PHS HHS
Comments/Corrections
Comment In:
Am J Transplant. 2010 Jul;10(7):1507-8   [PMID:  20642675 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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