Liver transplant recipient selection: MELD vs. clinical judgment

Authors

  • Michael A. Fink,

    Corresponding author
    1. Liver Transplant Unit Victoria, Melbourne, Australia
    2. The University of Melbourne Department of Surgery, Austin Hospital, Melbourne, Australia
    • FRACS, The University of Melbourne Department of Surgery, Austin Hospital, Heidelberg, Victoria 3084, Australia
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    • Telephone: 613 9496 5468; FAX: 613 9458 1650

  • Peter W. Angus,

    1. Liver Transplant Unit Victoria, Melbourne, Australia
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  • Paul J. Gow,

    1. Liver Transplant Unit Victoria, Melbourne, Australia
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  • S. Roger Berry,

    1. Liver Transplant Unit Victoria, Melbourne, Australia
    2. The University of Melbourne Department of Surgery, Austin Hospital, Melbourne, Australia
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  • Bao-Zhong Wang,

    1. Liver Transplant Unit Victoria, Melbourne, Australia
    2. The University of Melbourne Department of Surgery, Austin Hospital, Melbourne, Australia
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  • Vijayaragavan Muralidharan,

    1. Liver Transplant Unit Victoria, Melbourne, Australia
    2. The University of Melbourne Department of Surgery, Austin Hospital, Melbourne, Australia
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  • Christopher Christophi,

    1. Liver Transplant Unit Victoria, Melbourne, Australia
    2. The University of Melbourne Department of Surgery, Austin Hospital, Melbourne, Australia
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  • Robert M. Jones

    1. Liver Transplant Unit Victoria, Melbourne, Australia
    2. The University of Melbourne Department of Surgery, Austin Hospital, Melbourne, Australia
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Abstract

Minimization of death while waiting for liver transplantation involves accurate prioritization according to clinical status and appropriate allocation of donor livers. Clinical judgment in the Liver Transplant Unit Victoria (LTUV) was compared with Model for End-Stage Liver Disease (MELD) in a retrospective analysis of the LTUV database over the 2-year period August 1, 2002, through July 31, 2004. A total of 1,118 prioritization decisions occurred. Decisions were concordant in 758 (68%), comparing priorities assigned by clinical judgment with those assigned by MELD, P < 0.01. A total of 263 allocation decisions occurred. Decisions were concordant in 190 (72%) and 203 (77%) of the cases, comparing donor liver allocation with prioritization by MELD and clinical judgment, respectively. Of the 52 patients allocated a liver, only 23 would have been allocated on the basis of MELD while 29 had been prioritized on the waiting list in the week prior to transplantation. A total of 10 patients died on the waiting list in the 2-year period (annual adult waiting list mortality is 9.3%). Patients who subsequently died waiting were 3 times as likely to be prioritized by MELD as clinical judgment (29% vs. 9%, respectively). One half (3 of 6) of the patients who could have received a donor liver but who died waiting would have been allocated the organ on the basis of MELD. In conclusion, an allocation process based on MELD rather than clinical judgment would significantly alter organ allocation in Australia and may reduce waiting list mortality. (Liver Transpl 2005;11:621–626.)

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