4.7 Article

Reassessing the survival benefit of deceased donor liver transplantation: retrospective cohort study

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INTERNATIONAL JOURNAL OF SURGERY
卷 109, 期 9, 页码 2714-2720

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LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/JS9.0000000000000498

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benefit; liver; MELD; risk; survival; transplant

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This study challenges the current perception of the timing and benefits of DDLT in liver transplantation. The authors found that even at a low MELD-Na score of 12, DDLT provides a significant 1-year survival advantage compared to remaining on the waitlist, with a median estimated life years saved of over 9 years. Furthermore, as MELD-Na scores increase, the time-to-equal risk and time-to-equal survival decrease exponentially.
Introduction: Currently in the United States, deceased donor liver transplant (DDLT) allocation priority is based on the model for end-stage liver disease including sodium (MELD-Na) score. The United Network for organ sharing's 'Share-15' policy states that candidates with MELD-Na scores of 15 or greater have priority to receive local organ offers compared to candidates with lower MELD-Na scores. Since the inception of this policy, major changes in the primary etiologies of end-stage liver disease have occurred and previous assumptions need to be recalibrated. Methods: The authors retrospectively analyzed the Scientific Registry of Transplant Recipients database between 2012 and 2021 to determine life years saved by DDLT at each interval of MELD-Na score and the time-to-equal risk and time-to-equal survival versus remaining on the waitlist. The authors stratified our analysis by MELD exception points, primary disease etiology, and MELD score. Results: On aggregate, compared to remaining on the waitlist, a significant 1-year survival advantage of DDLT at MELD-Na scores as low as 12 was found. The median life years saved at this score after a liver transplant was estimated to be greater than 9 years. While the total life years saved were comparable across all MELD-Na scores, the time-to-equal risk and time-to-equal survival decreased exponentially as MELD-Na scores increased. Conclusion: Herein, the authors challenge the perception as to the timing of DDLT and when that benefit occurs. The national liver allocation policy is transitioning to a continuous distribution framework and these data will be instrumental to defining the attributes of the continuos allocation score.

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