Trotter James F, Osgood Michael J
Division of Gastroenterology/Hepatology, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
JAMA. 2004 Apr 21;291(15):1871-4. doi: 10.1001/jama.291.15.1871.
The Model for Endstage Liver Disease (MELD) score serves as the basis for the distribution of deceased-donor (DD) livers and was developed in response to "the final rule" mandate, whose stated principle is to allocate livers according to a patient's medical need, with less emphasis on keeping organs in the local procurement area. However, in selected areas of the United States, organs are kept in organ procurement organizations (OPOs) with small waiting lists and transplanted into less-sick patients instead of being allocated to sicker patients in nearby transplant centers in OPOs with large waiting lists.
To determine whether there is a difference in MELD scores for liver transplant recipients receiving transplants in small vs large OPOs.
Retrospective review of the US Scientific Registry of Transplant Recipients between February 28, 2002, and March 31, 2003. Transplant recipients (N = 4798) had end-stage liver disease and received DD livers.
MELD score distribution (range, 6-40), graft survival, and patient survival for liver transplant recipients in small (<100) and large (> or =100 on the waiting list) OPOs.
The distribution of MELD scores was the same in large and small OPOs; 92% had a MELD score of 18 or less, 7% had a MELD score between 19 and 24, and only 2% of listed patients had a MELD score higher than 24 (P =.85). The proportion of patients receiving transplants in small OPOs and with a MELD score higher than 24 was significantly lower than that in large OPOs (19% vs 49%; P<.001). Patient survival rates at 1 year after transplantation for small OPOs (86.4%) and large OPOs (86.6%) were not statistically different (P =.59), and neither were graft survival rates in small OPOs (80.1%) and large OPOs (81.3%) (P =.80).
There is a significant disparity in MELD scores in liver transplant recipients in small vs large OPOs; fewer transplant recipients in small OPOs have severe liver disease (MELD score >24). This disparity does not reflect the stated goals of the current allocation policy, which is to distribute livers according to a patient's medical need, with less emphasis on keeping organs in the local procurement area.
终末期肝病模型（MELD）评分是分配已故捐赠者（DD）肝脏的基础，它是为响应“最终规则”的要求而制定的，该规则的既定原则是根据患者的医疗需求分配肝脏，而较少强调将器官保留在当地采购区域。然而，在美国的某些地区，器官被保留在等待名单较短的器官采购组织（OPO）中，并移植给病情较轻的患者，而不是分配给等待名单较长的附近移植中心中病情较重的患者。
确定在小型与大型OPO中接受肝移植的受者的MELD评分是否存在差异。
对2002年2月28日至2003年3月31日期间美国移植受者科学登记处进行回顾性研究。移植受者（N = 4798）患有终末期肝病并接受了DD肝脏。
小型（<100）和大型（等待名单上≥100）OPO中肝移植受者的MELD评分分布（范围6 - 40）、移植物存活率和患者存活率。
大型和小型OPO中MELD评分的分布相同；92%的患者MELD评分为18或更低，7%的患者MELD评分为19至24，只有2%的登记患者MELD评分高于24（P = 0.85）。在小型OPO中接受移植且MELD评分高于24的患者比例显著低于大型OPO（19%对49%；P<0.001）。小型OPO（86.4%）和大型OPO（86.6%）移植后1年的患者存活率无统计学差异（P = 0.59），小型OPO（80.1%）和大型OPO（81.3%）的移植物存活率也无统计学差异（P = 0.80）。
小型与大型OPO中肝移植受者的MELD评分存在显著差异；小型OPO中患有严重肝病（MELD评分>24）的移植受者较少。这种差异并未反映当前分配政策的既定目标，即根据患者的医疗需求分配肝脏，而较少强调将器官保留在当地采购区域。
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