Division of Transplant, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.
Hepatology. 2012 Jul;56(1):149-56. doi: 10.1002/hep.25603. Epub 2012 Jun 18.
In many countries, the allocation of liver grafts is based on the Model of End-stage Liver Disease (MELD) score and the use of exception points for patients with hepatocellular carcinoma (HCC). With this strategy, HCC patients have easier access to transplantation than non-HCC ones. In addition, this system does not allow for a dynamic assessment, which would be required to picture the current use of local tumor treatment. This study was based on the Scientific Registry of Transplant Recipients and included 5,498 adult candidates of a liver transplantation for HCC and 43,528 for non-HCC diagnoses. A proportional hazard competitive risk model was used. The risk of dropout of HCC patients was independently predicted by MELD score, HCC size, HCC number, and alpha-fetoprotein. When combined in a model with age and diagnosis, these factors allowed for the extrapolation of the risk of dropout. Because this model and MELD did not share compatible scales, a correlation between both models was computed according to the predicted risk of dropout, and drop-out equivalent MELD (deMELD) points were calculated.
The proposed model, with the allocation of deMELD, has the potential to allow for a dynamic and combined comparison of opportunities to receive a graft for HCC and non-HCC patients on a common waiting list.
在许多国家，肝移植的分配基于终末期肝病模型（MELD）评分和对肝细胞癌（HCC）患者使用例外积分。采用该策略，HCC 患者比非 HCC 患者更容易获得移植。此外，该系统不允许进行动态评估，而这是需要对当前局部肿瘤治疗的使用情况进行评估所必需的。
本研究基于移植受者科学登记处，纳入了 5498 名 HCC 成人肝移植候选者和 43528 名非 HCC 诊断候选者。采用比例风险竞争风险模型。MELD 评分、HCC 大小、HCC 数量和甲胎蛋白独立预测 HCC 患者失访的风险。当将这些因素与年龄和诊断结合在一个模型中时，允许外推失访的风险。由于该模型和 MELD 没有共享兼容的范围，因此根据预测的失访风险计算了这两个模型之间的相关性，并计算了失访等效 MELD（deMELD）点。
该模型和 deMELD 的分配有可能允许对 HCC 和非 HCC 患者在普通等候名单上获得移植的机会进行动态和联合比较。
