Goldberg David S, Olthoff Kim M
Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania ; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania ; Leonard Davis Institute of Health Economics, University of Pennsylvania.
Division of Transplant Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania.
Curr Transplant Rep. 2014 Dec 1;1(4):232-237. doi: 10.1007/s40472-014-0027-4.
Since MELD-based allocation was implemented in 2002, a system of exception points has been in place in order to award increased waitlist priority to those patients whose severity of illness or risk of complications are not captured by the MELD score. These exceptions, categorized as standardized and non-standardized, have been used with increasing frequency over time. Several challenges to the exception point system have emerged, including lack of standardization in the criteria used to approve such exceptions, geographic variability in the use and approval of such exceptions, and limited evidence base to support certain exceptions. Herein, we summarize the current implementation of exception points, the challenges facing the transplant community, and suggestions for improving and standardizing the current exception point system.
自2002年实施基于终末期肝病模型（MELD）的分配系统以来，一直存在一个例外积分系统，以便将等待名单上的优先顺序提高给予那些疾病严重程度或并发症风险未被MELD评分所涵盖的患者。这些例外情况分为标准化和非标准化两类，随着时间的推移使用频率越来越高。例外积分系统出现了几个挑战，包括批准此类例外情况所使用标准缺乏标准化、此类例外情况的使用和批准存在地域差异，以及支持某些例外情况的证据基础有限。在此，我们总结了例外积分的当前实施情况、移植界面临的挑战以及改进和规范当前例外积分系统的建议。
