دورية أكاديمية
أعرض في EDS

Waitlist Outcomes for Exception and Non-exception Liver Transplant Candidates in the United States Following Implementation of the Median MELD at Transplant (MMaT)/250-mile Policy.

التفاصيل البيبلوغرافية
العنوان: Waitlist Outcomes for Exception and Non-exception Liver Transplant Candidates in the United States Following Implementation of the Median MELD at Transplant (MMaT)/250-mile Policy.
المؤلفون: Ishaque T; Department of Surgery, New York University Langone Transplant Institute, New York, NY.; Department of Surgery, New York University Grossman School of Medicine, New York, NY., Beckett J; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD., Gentry S; Department of Surgery, New York University Langone Transplant Institute, New York, NY.; Department of Surgery, New York University Grossman School of Medicine, New York, NY.; Scientific Registry of Transplant Recipients, Minneapolis, MN., Garonzik-Wang J; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI., Karhadkar S; Department of Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA., Lonze BE; Department of Surgery, New York University Langone Transplant Institute, New York, NY.; Department of Surgery, New York University Grossman School of Medicine, New York, NY., Halazun KJ; Department of Surgery, New York University Langone Transplant Institute, New York, NY.; Department of Surgery, New York University Grossman School of Medicine, New York, NY., Segev D; Department of Surgery, New York University Langone Transplant Institute, New York, NY.; Department of Surgery, New York University Grossman School of Medicine, New York, NY.; Scientific Registry of Transplant Recipients, Minneapolis, MN., Massie AB; Department of Surgery, New York University Langone Transplant Institute, New York, NY.; Department of Surgery, New York University Grossman School of Medicine, New York, NY.
المصدر: Transplantation [Transplantation] 2024 Aug 01; Vol. 108 (8), pp. e170-e180. Date of Electronic Publication: 2024 Mar 29.
نوع المنشور: Journal Article; Comparative Study
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0132144 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1534-6080 (Electronic) Linking ISSN: 00411337 NLM ISO Abbreviation: Transplantation Subsets: MEDLINE
أسماء مطبوعة: Publication: Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: Baltimore, Williams & Wilkins.
مواضيع طبية MeSH: Liver Transplantation*/adverse effects , Liver Transplantation*/mortality , Waiting Lists*/mortality , Carcinoma, Hepatocellular*/surgery , Carcinoma, Hepatocellular*/mortality , Liver Neoplasms*/surgery , Liver Neoplasms*/mortality , Registries* , End Stage Liver Disease*/surgery , End Stage Liver Disease*/mortality , End Stage Liver Disease*/diagnosis, Humans ; Male ; Female ; Middle Aged ; United States/epidemiology ; Adult ; Time Factors ; Aged ; Risk Factors ; Tissue and Organ Procurement ; Risk Assessment ; Patient Selection ; Treatment Outcome
مستخلص: Background: Since February 2020, exception points have been allocated equivalent to the median model for end-stage liver disease at transplant within 250 nautical miles of the transplant center (MMaT/250). We compared transplant rate and waitlist mortality for hepatocellular carcinoma (HCC) exception, non-HCC exception, and non-exception candidates to determine whether MMaT/250 advantages (or disadvantages) exception candidates.
Methods: Using Scientific Registry of Transplant Recipients data, we identified 23 686 adult, first-time, active, deceased donor liver transplant (DDLT) candidates between February 4, 2020, and February 3, 2022. We compared DDLT rates using Cox regression, and waitlist mortality/dropout using competing risks regression in non-exception versus HCC versus non-HCC candidates.
Results: Within 24 mo of study entry, 58.4% of non-exception candidates received DDLT, compared with 57.8% for HCC candidates and 70.5% for non-HCC candidates. After adjustment, HCC candidates had 27% lower DDLT rate (adjusted hazard ratio =  0.68 0.73 0.77 ) compared with non-exception candidates. However, waitlist mortality for HCC was comparable to non-exception candidates (adjusted subhazard ratio [asHR] =  0.93 1.03 1.15 ). Non-HCC candidates with pulmonary complications of cirrhosis or cholangiocarcinoma had substantially higher risk of waitlist mortality compared with non-exception candidates (asHR =  1.27 1.70 2.29 for pulmonary complications of cirrhosis, 1.35 2.04 3.07 for cholangiocarcinoma). The same was not true of non-HCC candidates with exceptions for other reasons (asHR =  0.54 0.88 1.44 ).
Conclusions: Under MMaT/250, HCC, and non-exception candidates have comparable risks of dying before receiving liver transplant, despite lower transplant rates for HCC. However, non-HCC candidates with pulmonary complications of cirrhosis or cholangiocarcinoma have substantially higher risk of dying before receiving liver transplant; these candidates may merit increased allocation priority.
Competing Interests: This work was supported by grants R01DK132395 (A.B.M.) from the National Institute of Diabetes and Digestive and Kidney Diseases and K24AI144954 (D.S.) from the National Institute of Allergy and Infectious Diseases. The other authors declare no conflicts of interest.
(Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
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تواريخ الأحداث: Date Created: 20240329 Date Completed: 20240723 Latest Revision: 20240723
رمز التحديث: 20240723
DOI: 10.1097/TP.0000000000004957
PMID: 38548691
قاعدة البيانات: MEDLINE
الوصف
تدمد:1534-6080
DOI:10.1097/TP.0000000000004957