title: Comparison of two equivalent model for end-stage liver disease scores for hepatocellular carcinoma patients using data from the United Network for Organ Sharing liver transplant waiting list registry.
abstract: Patients with hepatocellular carcinoma (HCC) have been advantaged on the liver transplant waiting list within the United States, and a 6-month delay and exception point cap have recently been implemented to address this disparity. An alternative approach to prioritization is an HCC-specific scoring model such as the MELD Equivalent (MELDEQ) and the mixed new deMELD. Using data on adult patients added to the UNOS waitlist between 30 September 2009 and 30 June 2014, we compared projected dropout and transplant probabilities for patients with HCC under these two models. Both scores matched actual non-HCC dropout in groups with scores <22 and improved equity with non-HCC transplant probabilities overall. However, neither score matched non-HCC dropout accurately for scores of 25-40 and projected dropout increased beyond non-HCC probabilities for scores <16. The main differences between the two scores were as follows: (i) the MELDEQassigns 6.85 more points after 6 months on the waitlist and (ii) the deMELD gives greater weight to tumor size and laboratory MELD. Post-transplant survival was lower for patients with scores in the 22-30 range compared with those with scores <16 (P = 0.007, MELDEQ; P = 0.015, deMELD). While both scores result in better equity of waitlist outcomes compared with scheduled progression, continued development and calibration is recommended.
authors.affiliation: Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Alver
authors.affiliation: Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Lorenz
authors.affiliation: Division of Transplantation Surgery, Department of Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Washburn
authors.affiliation: Department of Transplantation and Liver Surgery, Geisinger Medical Center, Danville, PA, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Marvin
authors.affiliation: Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA.
authors.forename: Guy N
authors.identifier: http://orcid.org/0000-0001-5317-079X
authors.initials: GN
authors.lastname: Brock
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality / Q000592:standards*; D009927:Tissue and Organ Procurement / Q000592:standards*; D014481:United States; D014850:Waiting Lists
keywords: equity; equivalent model for end-stage liver disease scores; hepatocellular carcinoma; transplant prioritization; waitlist dropout