Clinical

New liver transplant allocation policy improves outcome in patients with cancer

Last Updated: 2004-01-08 10:48:32 -0400 (Reuters Health)

By Karla Gale

NEW YORK (Reuters Health) - After the United Network of Organ Sharing implemented a new allocation policy in 2002 increasing the priority of patients with hepatocellular carcinoma (HCC), such candidates were more likely to survive until liver transplantation and to be well enough to survive the procedure, a new study shows.

The model for end-stage liver disease (MELD) is a tool used to estimate mortality, Dr. Vijayan Balan and colleagues explain in a special article, published in the January issue of Liver Transplantation. In February 27, 2002, the Network implemented a new MELD-based allocation policy giving priority to patients with HCC.

Up until this change, "when we prioritized these patients, they may not have gotten the highest priority score," Dr. Balan told Reuters Health. "But by the time they get sick enough to generate a high priority score, the cancer has advanced so much that they can't be transplanted, and that's the reason why UNOS decided to give them a priority score."

Dr. Balan and his team evaluated the impact of the change on patients with HCC. Included were 912 patients listed in the pre-MELD period, 805 who were listed prior to the policy change but who survived beyond this date, and 357 listed during the post-MELD period.

The percentage of HCC candidates dropped from waiting lists because of clinical deterioration or death dropped from 25.9% pre-MELD, to 8.0% for those in the overlap period, and 6.7% post-meld. Average time to transplant dropped from 2.28 years prior to the change to 0.69 years afterward.

"The 5-month survival after DDLT (deceased-donor liver transplantation) was similar for both time periods," the investigators report.

According to Dr. Balan, "The MELD system has made it more fair, in the sense that the patients who are most in need of a liver transplant are getting a liver. I do not think it has affected the survival of other [liver disease] patients at all."

Out of concern that HCC candidates were being given excessive priority, the Network decreased their priority score somewhat, effective February, 2003. Although the effect of this change on patients' survival has yet to be investigated, "my suspicion is that it will not adversely affect the patients with liver cancer," Dr. Balan added.

Liver Transpl 2004;10.