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

Dirchwolf, Melisa; Becchetti, Chiara; Gschwend, Sarah G; Toso, Christian; Dutkowski, Philipp; Immer, Franz; Beyeler, Franziska; Rossi, Simona; Schropp, Jonas; Dufour, Jean-François; Banz, Vanessa (2022). The MELD upgrade exception: a successful strategy to optimize access to liver transplantation for patients with high waiting list mortality. HPB : official journal of The International Hepato-Pancreato-Biliary Association, 24(7), pp. 1168-1176. Elsevier 10.1016/j.hpb.2021.12.009

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BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSION

Only patients with MELD Upgrade exceptions had the expected combination of higher waiting list mortality and quicker access to liver transplantation.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Visceral Surgery
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology
04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine

UniBE Contributor:

Becchetti, Chiara, Dufour, Jean-François, Banz Wüthrich, Vanessa

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1365-182X

Publisher:

Elsevier

Language:

English

Submitter:

Rahel Fuhrer

Date Deposited:

21 Jun 2022 14:23

Last Modified:

05 Dec 2022 16:21

Publisher DOI:

10.1016/j.hpb.2021.12.009

PubMed ID:

35065891

BORIS DOI:

10.48350/170759

URI:

https://boris.unibe.ch/id/eprint/170759

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