scholarly journals Liver Transplantation for T2 Hepatocellular Carcinoma during the COVID-19 Pandemic: A Novel Model Balancing Individual Benefit against Healthcare Resources

Cancers ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 1416
Author(s):  
Umberto Cillo ◽  
Alessandro Vitale ◽  
Michael L. Volk ◽  
Anna Chiara Frigo ◽  
Paolo Feltracco ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Quantitative Model ◽  
Meld Score ◽  
Waiting List ◽  
Ethical Framework ◽  
Organ Shortage ◽  
Net Benefit ◽  
The Individual ◽  
End Stage

The COVID-19 pandemic caused temporary drops in the supply of organs for transplantation, leading to renewed debate about whether T2 hepatocellular carcinoma (HCC) patients should receive priority during these times. The aim of this study was to provide a quantitative model to aid decision-making in liver transplantation for T2 HCC. We proposed a novel ethical framework where the individual transplant benefit for a T2 HCC patient should outweigh the harm to others on the waiting list, determining a “net benefit”, to define appropriate organ allocation. This ethical framework was then translated into a quantitative Markov model including Italian averages for waiting list characteristics, donor resources, mortality, and transplant rates obtained from a national prospective database (n = 8567 patients). The net benefit of transplantation in a T2 HCC patient in a usual situation varied from 0 life months with a model for end-stage liver disease (MELD) score of 15, to 34 life months with a MELD score of 40, while it progressively decreased with acute organ shortage during a pandemic (i.e., with a 50% decrease in organs, the net benefit varied from 0 life months with MELD 30, to 12 life months with MELD 40). Our study supports the continuation of transplantation for T2 HCC patients during crises such as COVID-19; however, the focus needs to be on those T2 HCC patients with the highest net survival benefit.

scholarly journals Impact of Integrating Insulin-Like Growth Factor 1 Levels into Model for End-Stage Liver Disease Score for Survival Prediction in Hepatocellular Carcinoma Patients

Oncology ◽  
2020 ◽  
Vol 98 (12) ◽  
pp. 836-846
Author(s):  
Reham Abdel-Wahab ◽  
Manal M. Hassan ◽  
Bhawana George ◽  
Roberto Carmagnani Pestana ◽  
Lianchun Xiao ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Disease ◽  
Growth Factor ◽  
Meld Score ◽  
Waiting List ◽  
Survival Prediction ◽  
Insulin Like Growth Factor ◽  
Priority Assignment ◽  
End Stage Liver Disease ◽  
End Stage

<b><i>Background:</i></b> Liver reserve affects survival in hepatocellular carcinoma (HCC). Model for End-Stage Liver Disease (MELD) score is used to predict overall survival (OS) and to prioritize HCC patients on the transplantation waiting list, but more accurate models are needed. We hypothesized that integrating insulin-like growth factor 1 (IGF-1) levels into MELD score (MELD-IGF-1) improves OS prediction as compared to MELD. <b><i>Methods:</i></b> We measured plasma IGF-1 levels in training (<i>n</i> = 310) and validation (<i>n</i> = 155) HCC cohorts and created MELD-IGF-1 score. Cox models were used to determine the association of MELD and MELD-IGF-1 with OS. Harrell’s c-index was used to compare the predictive capacity. <b><i>Results:</i></b> IGF-1 was significantly associated with OS in both cohorts. Patients with an IGF-1 level of ≤26 ng/mL in the training cohort and in the validation cohorts had significantly higher hazard ratios than patients with the same MELD but IGF-1 &#x3e;26 ng/mL. In both cohorts, MELD-IGF-1 scores had higher c-indices (0.60 and 0.66) than MELD scores (0.58 and 0.60) (<i>p</i> &#x3c; 0.001 in both cohorts). Overall, 26% of training and 52.9% of validation cohort patients were reclassified into different risk groups by MELD-IGF-1 (<i>p</i> &#x3c; 0.001). <b><i>Conclusions:</i></b> After independent validation, the MELD-IGF-1 could be used to risk-stratify patients in clinical trials and for priority assignment for patients on liver transplantation waiting list.

A Critical Review of MELD as a Reliable Tool for Transplant Prioritization

2019 ◽  
Vol 39 (04) ◽  
pp. 403-413 ◽  
Author(s):  
Sophie-Caroline Sacleux ◽  
Didier Samuel
Keyword(s):  
United States ◽  
Serum Creatinine ◽  
International Normalized Ratio ◽  
The United States ◽  
Meld Score ◽  
Waiting List ◽  
Organ Shortage ◽  
Short Term ◽  
Short Term Mortality ◽  
End Stage

AbstractIn a context of global organ shortage, the Model for End-Stage Liver Disease (MELD) score seems to be a fair prioritization tool, with a paradigm: “sickest first.” Since its introduction in the United States in 2002, it has been rapidly adopted by transplant centers and organ sharing agencies around the world. The MELD score showed its effectiveness with a 12% reduction in waiting list mortality in the United States. Its success is linked to its simplicity, the use of basic variables (serum creatinine, serum bilirubin, and international normalized ratio [INR]), and its ability to predict short-term mortality, particularly on the transplant waiting list. However, this score is not perfect: its variables may have disadvantages for some patients, especially women, with serum creatinine and interlaboratory variability of the INR. The MELD score does not take into account some variables associated with poor short-term prognosis in cirrhotic patients. In addition, it is currently capped at 40, which results in the exclusion of sicker patients who could greatly benefit from transplantation. Finally, the MELD score does not accurately reflect the prognosis of several conditions, requiring a MELD exception system. Some solutions have been suggested such as MELD-Na or MELD uncapping, but it has not yet been fully accepted by all transplant centers.

The effect of bridging locoregional therapies on survival in hepatocellular carcinoma patients undergoing orthotopic liver transplantation: UNOS population study.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 346-346 ◽  
Author(s):  
Minzhi Xing ◽  
Hyun Sik Kim
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Orthotopic Liver Transplantation ◽  
Large Scale ◽  
Population Based ◽  
Meld Score ◽  
Kaplan Meier ◽  
Comparison Groups ◽  
Locoregional Therapies ◽  
End Stage

346 Background: The effect of bridging locoregional therapies (LRT) on overall survival (OS) in pts with hepatocellular carcinoma (HCC) undergoing orthotopic liver transplantation (OLT) has not been investigated in large-scale population studies. Methods: TheUnited Network for Organ Sharing (UNOS) database was used to identify pts with HCC who received OLT between 2002 and 2010. Pts within Milan Criteria for whom an HCC Model for End-Stage Liver Disease (MELD) exception was approved were included. OS was compared between pts who received bridging LRT (including transarterial chemoembolization (TACE)) and those who did not. Kaplan-Meier estimation and Cox proportional hazard models were used for OS analysis. Results: Of 11,287 pts with HCC who received OLT, 9,876 pts had LRT data, mean age 56.6 yrs, 77% male; 5,103 received bridging LRT, including 3,676 who received TACE. Comparison groups were similar for age at OLT, waitlist duration, sex, race, BMI and MELD score (p>.05 for all). Significantly prolonged OS with bridging LRT vs. none was observed from both OLT (111.6 vs 106.4 mo, p<.001) and from Listing (176.1 vs 169.4 mo, p=.001). Similarly, significantly prolonged OS with bridging TACE vs. none was observed from both OLT (112.0 vs 107.2 mo, p<.001) and from Listing (177.7 vs 169.9 mo, p=.001). Conclusions: In HCC pts undergoing OLT, both bridging LRT and TACE correlated with prolonged survival from OLT and from Listing in a UNOS population-based study. [Table: see text]

Analysis of Model for End-Stage Liver Disease (MELD) Score in a Liver Transplantation Waiting List

2007 ◽  
Vol 39 (8) ◽  
pp. 2511-2513 ◽  
Author(s):  
B.-H. Ferraz-Neto ◽  
R. Hidalgo ◽  
T. Thomé ◽  
V.A. Melo ◽  
A. Lobue ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Meld Score ◽  
Waiting List ◽  
End Stage Liver Disease ◽  
End Stage

scholarly journals Liver Transplantation: Evolving Patient Selection Criteria

2001 ◽  
Vol 15 (11) ◽  
pp. 729-738 ◽  
Author(s):  
Andy S Yu ◽  
Aijaz Ahmed ◽  
Emmet B Keeffe
Keyword(s):  
United States ◽  
Liver Transplantation ◽  
Liver Disease ◽  
Waiting Times ◽  
The United States ◽  
Meld Score ◽  
Chronic Liver ◽  
Waiting List ◽  
The Individual ◽  
Donor Organs

The widespread recognition of the success of liver transplantation as a treatment for most types of acute and chronic liver failure has led to increased referrals for transplantation in the setting of a relatively fixed supply of cadaver donor organs. These events have led to a marked lengthening of the waiting time for liver transplantation, resulting in increased deaths of those on the waiting list and sicker patients undergoing transplantation. Nearly 5000 liver transplantations were performed in the United States in 2000, while the waiting list grew to over 17,000 patients. The mounting disparity between the number of liver transplant candidates and the limited supply of donor organs has led to reassessment of the selection and listing criteria for liver transplantation, as well as revision of organ allocation and distribution policies for cadaver livers. The development of minimal listing criteria for patients with chronic liver disease based on a specific definition for decompensation of cirrhosis has facilitated the more uniform listing of patients at individual centres across the United States. The United Network for Organ Sharing, under pressure from transplant professionals, patient advocacy groups and the federal government, has continuously revised allocation and distribution policies based on the ethical principles of justice for the individual patient versus optimal utility of the limited organ supply available annually. Beginning in 2002, it is likely that the Model for End-stage Liver Disease (MELD) score will be implemented to determine disease severity and direct donor organs to the sickest patients rather than to those with the longest waiting times.

scholarly journals The Effects of MELD-Based Liver Allocation on Patient Survival and Waiting List Mortality in a Country with a Low Donation Rate

2020 ◽  
Vol 9 (6) ◽  
pp. 1929
Author(s):  
Paul V. Ritschl ◽  
Leke Wiering ◽  
Tomasz Dziodzio ◽  
Maximilian Jara ◽  
Jochen Kruppa ◽  
...  
Keyword(s):  
Patient Survival ◽  
Relative Number ◽  
Meld Score ◽  
Waiting List ◽  
Organ Shortage ◽  
Liver Allocation ◽  
German Organ Transplantation Foundation ◽  
Liver Transplantations ◽  
Prognostic Outcome ◽  
End Stage

The Model for End-Stage Liver Disease (MELD)-based allocation system was implemented in Germany in 2006 in order to reduce waiting list mortality. The purpose of this study was to evaluate post-transplant results and waiting list mortality since the introduction of MELD-based allocation in our center and in Germany. Adult liver transplantation at the Charité—Universitätsmedizin Berlin was assessed retrospectively between 2005 and 2012. In addition, open access data from Eurotransplant (ET) and the German Organ Transplantation Foundation (DSO) were evaluated. In our department, 861 liver transplantations were performed from 2005 to 2012. The mean MELD score calculated with the laboratory values last transmitted to ET before organ offer (labMELD) at time of transplantation increased to 20.1 from 15.8 (Pearson’s R = 0.121, p < 0.001, confidence interval (CI) = 0.053–0.187). Simultaneously, the number of transplantations per year decreased from 139 in 2005 to 68 in 2012. In order to overcome this organ shortage the relative number of utilized liver donors in Germany has increased (85% versus 75% in non-German ET countries). Concomitantly, 5-year patient survival decreased from 79.9% in 2005 to 60.3% in 2012 (p = 0.048). At the same time, the ratio of waiting list mortality vs. active-listed patients nearly doubled in Germany (Spearman’s rho = 0.903, p < 0.001, CI = 0.634–0.977). In low-donation areas, MELD-based liver allocation may require reconsideration and inclusion of prognostic outcome factors.

scholarly journals Comparing different risk factors associated with delisting of hepatocellular carcinoma patients candidates for liver transplantation

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
K Z Elkarmouty ◽  
M M B Ahmed ◽  
H H ElKilany ◽  
H S Rasmy ◽  
R S Mohamed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Deceased Donor ◽  
Waiting List ◽  
Donor Liver Transplantation ◽  
Transplant Patients ◽  
Specialized Hospital ◽  
Related Donor ◽  
End Stage

Abstract Background Hepatocellular carcinoma (HCC) is the fifth most common cancer worldwide, with more than 1 million new cases diagnosed every year. Liver transplantation (LT) has been used as a curative treatment for patients with HCC. In countries where the liver allograft allocation is based on the Model for End-Stage Liver Disease (MELD) system, patients with HCC within the Milan criteria (MC) receive exception points, preventing dropout from the list. Objective The aim of this study is to analyse the different risk factors leading to delisting in liver transplant patients with hepatocellular carcinoma. Methods This study was a retrospective cohort study which had been carried out during the period between January 2017 to June 2018. During it, 48 patients were listed for LDLT at Ain Shams Center for Organ Transplantation (ASCOT) at Ain Shams Specialized Hospital till liver transplantation. By the end of this period 29 patients were delisted due to several reasons while 12 got transplanted and 7 were still on the waiting list. The study protocol was approved by the medical ethics committee of Ain Shams University. Results Regarding this study’s results, 25% were transplanted, 60.42% were delisted and 14.58% remained on the waiting list. 51.72% of patients in this study were delisted due to unavailability of related donor. In this center only related donors were allowed to donate as it follows Egypt’s organ donation policies, there are no organ allocation systems and deceased donor liver transplantation is illegal limiting availability of donors. Conclusion At the end of this study we can conclude that, age and tumour classification were independent predictors of delisting HCC patients candidates for liver transplantation.

scholarly journals Liver transplantation: expectation with MELD score for liver allocation in Brazil

2006 ◽  
Vol 21 (suppl 1) ◽  
pp. 12-14 ◽  
Author(s):  
Andreza Correa Teixeira ◽  
Fernanda Fernandes Souza ◽  
Gustavo de Assis Mota ◽  
Ana de Lourdes Candolo Martinelli ◽  
Ajith Kumar Sankarankutty ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Disease ◽  
Meld Score ◽  
Waiting List ◽  
End Stage Liver Disease ◽  
Liver Allocation ◽  
Number Of Patients ◽  
Severe Liver Disease ◽  
End Stage ◽  
New Criterion

Liver transplantation represents the most effective therapy for patients suffering from chronic end-stage liver disease. Until very recently, in Brazil, liver allocation was based on the Child-Turcotte-Pugh score and the waiting list followed a chronological criterion. In February 2002 the Model for End-stage Liver Disease (MELD) score was adopted for the allocation of donor livers in the US. After that change, an increased number of patients with more severe liver disease was observed, although there was no difference in 1-year patient and graft survival. A reduction in waiting-list mortality was also observed. In Brazil, the MELD score was adopted on May 31st, 2006. Good results are expected regarding the new criterion for allocation.

scholarly journals A preoperative nomogram predicts prognosis of patients with hepatocellular carcinoma after liver transplantation: a multicenter retrospective study

BMC Cancer ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dabing Huang ◽  
Yinan Shen ◽  
Wei Zhang ◽  
Chengxiang Guo ◽  
Tingbo Liang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Adjuvant Therapy ◽  
Validation Cohort ◽  
Multivariate Analyses ◽  
Meld Score ◽  
Blood Type ◽  
Intermediate Risk ◽  
Final Model ◽  
Using Data

Abstract Background Although criteria for liver transplantation, such as the Milan criteria and Hangzhou experiences, have become popular, criteria to guide adjuvant therapy for patients with hepatocellular carcinoma after liver transplantation are lacking. Methods We collected data from all consecutive patients from 2012 to 2019 at three liver transplantation centers in China retrospectively. Univariate and multivariate analyses were used to analyze preoperative parameters, such as demographic and clinical data. Using data obtained in our center, calibration curves and the concordance Harrell’s C-indices were used to establish the final model. The validation cohort comprised the patients from the other centers. Results Data from 233 patients were used to construct the nomogram. The validation cohort comprised 36 patients. Independent predictors of overall survival (OS) were identified as HbeAg positive (P = 0.044), blood-type compatibility unmatched (P = 0.034), liver transplantation criteria (P = 0.003), and high MELD score (P = 0.037). For the validation cohort, to predict OS, the C-index of the nomogram was 0.874. Based on the model, patients could be assigned into low-risk (≥ 50%), intermediate-risk (30–50%), and high-risk (≤ 30%) groups to guide adjuvant therapy after surgery and to facilitate personalized management. Conclusions The OS in patients with hepatocellular carcinoma after liver transplantation could be accurately predicted using the developed nomogram.

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