1. A method for establishing allocation equity among patients with and without hepatocellular carcinoma on a common liver transplant waiting list
- Author
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Vitale, A, Volk, Ml, De Feo TM, Burra, P, Frigo, Ac, Ramirez Morales, R, De Carlis, L, Belli, L, Colledan, M, Fagiuoli, S, Rossi, G, Andorno, E, Baccarani, U, Regalia, E, Vivarelli, M, Donataccio, M, Russo, Fp, Angeli, P, for Liver Transplantation North Italy Transplant program (NITp) working group, Cillo, U., Vitale, A, Volk, M, De Feo, T, Burra, P, Frigo, A, Ramirez Morales, R, DE CARLIS, L, Belli, L, Colledan, M, Fagiuoli, S, Rossi, G, Andorno, E, Baccarani, U, Regalia, E, Vivarelli, M, Donataccio, M, and Cillo, U
- Subjects
Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Tissue and Organ Procurement ,Waiting Lists ,Hepatocellular carcinoma ,medicine.medical_treatment ,Liver transplantation ,Gastroenterology ,Severity of Illness Index ,End Stage Liver Disease ,Liver disease ,Model for End-Stage Liver Disease ,Interquartile range ,Internal medicine ,Medicine ,Humans ,Proportional Hazards Models ,Cirrhosi ,Hepatology ,Surgical oncology ,Cirrhosis ,Clinical decision making ,business.industry ,Proportional hazards model ,Hazard ratio ,Liver Neoplasms ,Transplant Waiting List ,Middle Aged ,medicine.disease ,digestive system diseases ,Markov Chains ,Italy ,Female ,business ,Monte Carlo Method - 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
- Published
- 2014