Rodriguez-Luna Hector, Vargas Hugo E, Moss Adyr, Reddy Kunam S, Freeman Richard B, Mulligan David
Transplantation Medicine, Mayo Clinic Hospital, Phoenix, Arizona, USA.
Am J Transplant. 2005 Sep;5(9):2244-7. doi: 10.1111/j.1600-6143.2005.01008.x.
The Model for End-Stage Liver Disease (MELD) is used to assign priority for liver transplantation candidates. The Organ Procurement and Transplantation Network (OPTN) approved recognized exceptional diagnoses (RED's) for which MELD fails to accurately measure priority. Centers can request increased MELD points in cases not recognized by this policy (non-RED's). Our aim was to compare regional practices to justify non-RED requests for MELD adjustments. The UNOS/OPTN database was queried to extract all adult cases for which a non-RED MELD adjustment was requested from 2/27/02 until 8/27/03. The data were stratified by region and justification. Data for 29,510 listings were available. 26,947 had complete diagnosis information. There were 827 non-RED requests of which 477 (57.7%) petitions were approved by the regional review boards (RRBs). The approval rate varied significantly among regions (range: 28-75%, p<0.0001). The most common non-RED's were complications of portal hypertension (48%). The percentage of patients listed with non-RED's varied significantly among regions (0.7-8.3 %, p<0.0001), as did the proportion of patients transplanted with non-RED's (2.1-31.9%, p<0.0001). Demographics did not differ among regions requesting non-REDs.Widespread regional variations exist in the handling of requests for non-REDs. These variations point to the need for reform to standard exception criteria.
终末期肝病模型（MELD）用于确定肝移植候选者的优先级。器官获取与移植网络（OPTN）批准了一些公认的特殊诊断（RED），对于这些情况MELD无法准确衡量优先级。在该政策未认可的病例（非RED）中，各中心可申请增加MELD分数。我们的目的是比较不同地区的做法，以证明对非RED申请调整MELD的合理性。查询了UNOS/OPTN数据库，以提取2002年2月27日至2003年8月27日期间所有申请非RED的MELD调整的成人病例。数据按地区和理由进行分层。有29510条登记数据可用。26947条有完整的诊断信息。有827项非RED申请，其中477项（57.7%）申请获得地区评审委员会（RRB）批准。各地区的批准率差异显著（范围：28%-75%，p<0.0001）。最常见的非RED是门静脉高压并发症（48%）。各地区列出的非RED患者百分比差异显著（0.7%-8.3%，p<0.0001），接受非RED移植的患者比例也如此（2.1%-31.9%，p<0.0001）。申请非RED的地区之间人口统计学特征无差异。在处理非RED申请方面存在广泛的地区差异。这些差异表明需要改革标准例外标准。
