Regional Variability in Symptom-Based MELD Exceptions: A Response to Organ Shortage?
Article first published online: 26 OCT 2011
©Copyright 2011 The American Society of Transplantation and the American Society of Transplant Surgeons
American Journal of Transplantation
Volume 11, Issue 11, pages 2353–2361, November 2011
How to Cite
Argo, C. K., Stukenborg, G. J., Schmitt, T. M., Kumer, S. C., Berg, C. L. and Northup, P. G. (2011), Regional Variability in Symptom-Based MELD Exceptions: A Response to Organ Shortage?. American Journal of Transplantation, 11: 2353–2361. doi: 10.1111/j.1600-6143.2011.03738.x
- Issue published online: 26 OCT 2011
- Article first published online: 26 OCT 2011
- Received 30 March 2010, revised 13 May 2011 and accepted for publication 18 May 2011
- liver transplantation;
- organ allocation;
- UNOS region;
- waiting list
MELD (model for end-stage liver disease) exception awards affect the liver allocation process. Award rates of specific nonhepatocellular carcinoma exceptions, termed symptom-based exceptions (SBE), differ across UNOS regions. We aimed to characterize the regional variability in SBE awards and examine predictive factors for receiving a SBE in the MELD era. The OPTN liver transplant and waiting list dataset was analyzed for waiting list registrants during the MELD allocation on February 27, 2002, until November 22, 2006. Competing risks proportional hazards regression analysis was used to examine predictors for receiving a SBE in 39 169 registrants. The hazard ratios for receiving a SBE differed significantly across regions when adjusted for multiple variables including age, gender, ethnicity, physiologic MELD score, blood group, functional status, etiology of liver disease, insurer and education level. Utilization of SBE is highly significantly variable across UNOS regions, and does not correlate with organ availability as estimated by the regional mean physiologic MELD score at transplantation. Patients with Medicaid as their primary payer have a lower likelihood of receiving a SBE award, while patients with cryptogenic/NASH cirrhosis or cholestatic liver disease have a higher likelihood of receiving a SBE. Reasons for these regional and demographic disparities deserve further investigation.