Division of Biostatistics and Bioinformatics, Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD 21201-1596, USA.
Transpl Int. 2012 Apr;25(4):409-15. doi: 10.1111/j.1432-2277.2012.01431.x. Epub 2012 Feb 2.
The patients with end-stage liver disease (ESLD) on the liver transplant waiting list are prioritized for transplant based on the model for end-stage liver disease (MELD) score. We developed and used an innovative approach to compare MELD to six proposed alternatives with respect to waiting list mortality. Our analysis was based on United Network for Organ Sharing data of patients with ESLD on the waiting list between January 2006 and June 2009. We compared six allocation models to MELD. Two models were based on reweighting the variables used by MELD: an "updated" MELD, and ReFit MELD. Four models also included serum sodium: MESO, MeldNa, UKELD, and ReFit MELDNa. We estimated that UKELD and the updated MELD would result in significantly fewer lives saved. There were no significant differences between the other models. Our new approach can supplement standard methods to provide insight into the relative performance of liver allocation models in reducing waiting list mortality. Our analysis suggests that UKELD and the updated MELD score would not be optimal for reducing waiting list mortality in the United States.
终末期肝病（ESLD）患者根据终末期肝病模型（MELD）评分在肝移植等待名单上优先考虑移植。我们开发并使用了一种创新方法，比较了 MELD 与其他六种替代方案在等待名单死亡率方面的表现。我们的分析基于 2006 年 1 月至 2009 年 6 月期间在等待名单上的 ESLD 患者的美国器官共享网络数据。我们将六种分配模型与 MELD 进行了比较。两种模型基于对 MELD 所使用变量的重新加权：“更新的”MELD 和 ReFit MELD。另外四种模型也包括血清钠：MESO、MeldNa、UKELD 和 ReFit MELDNa。我们估计 UKELD 和更新的 MELD 将导致显著较少的生命得到挽救。其他模型之间没有显著差异。我们的新方法可以补充标准方法，为评估肝脏分配模型在降低等待名单死亡率方面的相对表现提供了深入了解。我们的分析表明，UKELD 和更新的 MELD 评分在美国不是降低等待名单死亡率的最佳选择。
