title: Validation of a dropout assessment model of candidates with/without hepatocellular carcinoma on a common liver transplant waiting list.
abstract: The model of end-stage liver disease (MELD) score is often used for liver graft allocation, and patients with hepatocellular carcinoma (HCC) receive exception points (22 in the US). A better model is desirable for patients with HCC as they tend to have a privileged access to transplantation, without taking HCC characteristics into account. A new simpler model designed from a training set of US patients (n = 49 026) was tested on two validation sets (US and UK patient cohorts with, respectively, n = 20 475 and n = 1781). The risk of dropout was between 3.2 and 7.8% at 3 months in patients with HCC, and was captured into a score, including HCC size, HCC number, AFP, and MELD (-37.8 +1.9*MELD+5.9 if HCC Nb ≥ 2 + 5.9 if AFP > 400 + 21.2 if HCC size > 1 cm). This new model could be validated on external US and UK liver candidate cohorts. It provides a dynamic and more accurate assessment of dropout than the use of exception MELD (C-indices of 66.2-73.7% vs. 52.7-56.6%). In addition, the model shows a similar distribution as MELD for patients with non-HCC, and both scores could be used in parallel for the management of waiting-list patients with and without HCC.
authors.affiliation: Divisions of Transplant and Abdominal Surgery, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland; Hepato-Pancreato-Biliary Centre, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Toso
authors.forename: Pietro
authors.initials: P
authors.lastname: Majno
authors.forename: Thierry
authors.initials: T
authors.lastname: Berney
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
authors.forename: Gilles
authors.initials: G
authors.lastname: Mentha
authors.forename: Christophe
authors.initials: C
authors.lastname: Combescure
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery; D058625:End Stage Liver Disease / Q000473:pathology / Q000601:surgery*; D005260:Female; D015276:Health Care Rationing; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts; D018579:Patient Selection; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D006113:United Kingdom; D014481:United States; D014850:Waiting Lists
keywords: MELD; allocation; deMELD; score; validation