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) |
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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 |