TY - JOUR
T1 - A method for establishing allocation equity among patients with and without hepatocellular carcinoma on a common liver transplant waiting list
AU - Vitale, Alessandro
AU - Volk, Michael L.
AU - De Feo, Tullia Maria
AU - Burra, Patrizia
AU - Frigo, Anna Chiara
AU - Ramirez Morales, Rafael
AU - De Carlis, Luciano
AU - Belli, Luca
AU - Colledan, Michele
AU - Fagiuoli, Stefano
AU - Rossi, Giorgio
AU - Andorno, Enzo
AU - Baccarani, Umberto
AU - Regalia, Enrico
AU - Vivarelli, Marco
AU - Donataccio, Matteo
AU - Cillo, Umberto
PY - 2014/2
Y1 - 2014/2
N2 - Background & Aims The current organ allocation system for liver transplantation (LT) creates an imbalance between patients with and without hepatocellular carcinoma (HCC). We describe a model designed to re-establish allocation equity among patient groups using transplant benefit as the common endpoint. Methods We enrolled consecutive adult patients entering the waiting list (WL group, n = 2697) and undergoing LT (LT group, n = 1702) during the period 2004-2009 in the North Italy Transplant program area. Independent multivariable regressions (WL and LT models) were created for patients without HCC and for those with stage T2 HCC. Monte Carlo simulation was used to create distributions of transplant benefit, and covariates such as Model for End-stage Liver Disease (MELD) and alpha-fetoprotein (AFP) were combined in regression equations. These equations were then calibrated to create an "MELD equivalent" which matches HCC patients to non-HCC patients having the same numerical MELD score. Results Median 5 year transplant benefit was 15.12 months (8.75-25.35) for the non-HCC patients, and 28.18 months (15.11-36.38) for the T2-HCC patients (p
AB - Background & Aims The current organ allocation system for liver transplantation (LT) creates an imbalance between patients with and without hepatocellular carcinoma (HCC). We describe a model designed to re-establish allocation equity among patient groups using transplant benefit as the common endpoint. Methods We enrolled consecutive adult patients entering the waiting list (WL group, n = 2697) and undergoing LT (LT group, n = 1702) during the period 2004-2009 in the North Italy Transplant program area. Independent multivariable regressions (WL and LT models) were created for patients without HCC and for those with stage T2 HCC. Monte Carlo simulation was used to create distributions of transplant benefit, and covariates such as Model for End-stage Liver Disease (MELD) and alpha-fetoprotein (AFP) were combined in regression equations. These equations were then calibrated to create an "MELD equivalent" which matches HCC patients to non-HCC patients having the same numerical MELD score. Results Median 5 year transplant benefit was 15.12 months (8.75-25.35) for the non-HCC patients, and 28.18 months (15.11-36.38) for the T2-HCC patients (p
KW - Cirrhosis
KW - Clinical decision making
KW - Hepatocellular carcinoma
KW - Liver transplantation
KW - Surgical oncology
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U2 - 10.1016/j.jhep.2013.10.010
DO - 10.1016/j.jhep.2013.10.010
M3 - Article
C2 - 24161408
AN - SCOPUS:84892549105
VL - 60
SP - 290
EP - 297
JO - Journal of Hepatology
JF - Journal of Hepatology
SN - 0168-8278
IS - 2
ER -