Evaluation of liver transplant prioritization methods for hepatocellular carcinoma patients using multistate models.

HCC;Liver Transplantation;Multistate Models;MELD

Sarah Katharine Alver

University:University of Louisville

Department:Bioinformatics and Biostatistics

关键词: HCC;    Liver Transplantation;    Multistate Models;    MELD;   

Others  :  https://ir.library.louisville.edu/cgi/viewcontent.cgi?article=3284&context=etd

美国|英语

来源: The Universite of Louisville's Institutional Repository

【 摘 要 】

The Model for End Stage Liver Disease (MELD), used for prioritizing liver transplantation, predicts mortality from liver disease. Patients with hepatocellular carcinoma (HCC) risk disease progression not reflected in their MELD score. Exception scores prioritize HCC patients higher than their MELD scores, but advantage them over non-HCC patients. To address this, a delay of six months for using exception scores has been implemented, and alternative HCC-specific scores have been developed. Using multistate models, this study projects waitlist dropout and transplant probabilities under the delay and under two alternative scores. The delay improves equity between HCC and non-HCC patients for the first six months waitlist time, but still advantages HCC patients after six months. Both alternative scores would improve this inequity but increase dropout for some HCC risk groups and decrease HCC transplant probabilities below non-HCC probabilities. Further calibration of these scores is recommended prior to considering them for implementation.