An Outcome-Based Approach to Assign MELD Exception Points for Patients With Hepatocellular Cancer.

Background: Current Model for End Stage Liver Disease (MELD) exception points provided to patients with hepatocellular cancer (HCC) are not based on outcome data and advantage these patients compared to those listed based on laboratory values (LABMELD). We sought to develop a data-based assignment for exception points for patients with HCC that equalizes outcomes among HCC and LABMELD patients. Methods: We used Scientific Registry of Transplant Recipients data to compare patients listed with HCC who received exception points versus patients listed with LABMELD. Nation and region-specific data were examined for 1) a composite outcome for adverse events of death, delisting, or becoming ineligible for transplant, and 2) transplant rate. We also determined MELD progression rates for LABMELD patients. Candidates listed with LABMELD scores were compared to those listed with 22 exception points for HCC (HCC22) to determine the LABMELD for which statistical parity was achieved for our composite outcome. Results: HCC22 candidates time to adverse event were comparable to LABMELD16 candidates (range 15-19) whereas time to transplant was comparable to LABMELD 22 candidates (range 21-23). LABMELD22 candidates had 2.1 times greater risk of adverse event compared to HCC22 (95%CI 1.9-2.4, range 1.5-2.4). Progression among LABMELD16 candidates whose scores did not improve was similar across regions and averaged 0.94 points/month (95% CI: 0.88-0.99, range 0.80-1.04). Conclusions: To equalize the occurrence of an adverse outcome, the proper listing MELD for patients with HCC is 16, with approximately 1 additional point/month. These results provide a data-driven algorithm to increase fairness in listing priority. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2pGtdEa