A method for establishing allocation equity among patients with and without hepatocellular carcinoma on a common liver transplant waiting list

Alessandro Vitale, Michael L. Volk, Tullia Maria De Feo, Patrizia Burra, Anna Chiara Frigo, Rafael Ramirez Morales, Luciano De Carlis, Luca Belli, Michele Colledan, Stefano Fagiuoli, Giorgio Rossi, Enzo Andorno, Umberto Baccarani, Enrico Regalia, Marco Vivarelli, Matteo Donataccio, Umberto Cillo

Research output: Contribution to journalArticlepeer-review

Abstract

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

Original languageEnglish
Pages (from-to)290-297
Number of pages8
JournalJournal of Hepatology
Volume60
Issue number2
DOIs
Publication statusPublished - Feb 2014

Keywords

  • Cirrhosis
  • Clinical decision making
  • Hepatocellular carcinoma
  • Liver transplantation
  • Surgical oncology

ASJC Scopus subject areas

  • Hepatology

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