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Model for End-stage Liver Disease Dynamic Stratification of Survival Benefit
Abstract Only patients with Model for End-stage Liver Disease (MELD) scores ≥18 or ≥17 experience a survival benefit (SB) at 12 and 36 months after liver transplantation (OLT). The SB calculation estimates the difference after stratification for risk categories between the survival rate of transplan...
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| Published in: | Transplantation proceedings 2012-09, Vol.44 (7), p.1851-1856 |
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| container_end_page | 1856 |
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| container_title | Transplantation proceedings |
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| creator | Avolio, A.W Siciliano, M Barone, M Lai, Q Caracciolo, G.L Barbarino, R Nicolotti, N Lirosi, M.C Gasbarrini, A Agnes, S |
| description | Abstract Only patients with Model for End-stage Liver Disease (MELD) scores ≥18 or ≥17 experience a survival benefit (SB) at 12 and 36 months after liver transplantation (OLT). The SB calculation estimates the difference after stratification for risk categories between the survival rate of transplanted versus waiting list patients. The aim of this study was to perform a short- and long-term (60 months) SB analyses of a Italian OLT program. One-hundred seventy-one patients were stratified into four MELD classes (6–14, 15–18, 19–25, 26–40), and two groups: namely, waiting list (WL) and transplanted groups (TX). The median waiting time for transplanted patients was 4.4 months (range, 0–35). SB was expressed as mortality hazard ratio (MHR) as obtained through a Cox regression analysis using as a covariate the status of each patient in the waiting list (WL = 0, reference group) or the TX group (TX = 1). Values over 1 indicated the MHR in favor of the WL with the values below 1 indicating MHR in favor of Tx. In the MELD class 6 to 14, the MHR was above 1 at 3 and 6 months, indicating an SB in favor of WL; subsequently, the MHR dropped below 1, indicating an SB in favor of TX ( P < .05). In the MELD class 15 to 18 the MHR was above 1 at 3 months, but below 1 subsequently ( P < .05). For MELD classes 19 to 25 and 26 to 40, the MHR was always below 1 ( P < .01). According to the SB approach, patients in the MELD class 6 to 14 could safely wait for at least 36 months; patients in the MELD class 15 to 18 should likely remain no longer than 12 months on the waiting list, and all the remaining patients with MELD > 18 should be transplanted as soon as possible. OLT should not be precluded but only postponed for MELD < 19 patients. |
| doi_str_mv | 10.1016/j.transproceed.2012.06.056 |
| format | article |
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The SB calculation estimates the difference after stratification for risk categories between the survival rate of transplanted versus waiting list patients. The aim of this study was to perform a short- and long-term (60 months) SB analyses of a Italian OLT program. One-hundred seventy-one patients were stratified into four MELD classes (6–14, 15–18, 19–25, 26–40), and two groups: namely, waiting list (WL) and transplanted groups (TX). The median waiting time for transplanted patients was 4.4 months (range, 0–35). SB was expressed as mortality hazard ratio (MHR) as obtained through a Cox regression analysis using as a covariate the status of each patient in the waiting list (WL = 0, reference group) or the TX group (TX = 1). Values over 1 indicated the MHR in favor of the WL with the values below 1 indicating MHR in favor of Tx. In the MELD class 6 to 14, the MHR was above 1 at 3 and 6 months, indicating an SB in favor of WL; subsequently, the MHR dropped below 1, indicating an SB in favor of TX ( P < .05). In the MELD class 15 to 18 the MHR was above 1 at 3 months, but below 1 subsequently ( P < .05). For MELD classes 19 to 25 and 26 to 40, the MHR was always below 1 ( P < .01). According to the SB approach, patients in the MELD class 6 to 14 could safely wait for at least 36 months; patients in the MELD class 15 to 18 should likely remain no longer than 12 months on the waiting list, and all the remaining patients with MELD > 18 should be transplanted as soon as possible. OLT should not be precluded but only postponed for MELD < 19 patients.</description><identifier>ISSN: 0041-1345</identifier><identifier>EISSN: 1873-2623</identifier><identifier>DOI: 10.1016/j.transproceed.2012.06.056</identifier><identifier>PMID: 22974854</identifier><identifier>CODEN: TRPPA8</identifier><language>eng</language><publisher>Amsterdam: Elsevier Inc</publisher><subject>Adult ; Biological and medical sciences ; End Stage Liver Disease - surgery ; Female ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; Gastroenterology. Liver. Pancreas. Abdomen ; Health Care Rationing ; Humans ; Italy ; Liver Transplantation ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Male ; Medical sciences ; Middle Aged ; Other diseases. Semiology ; Regression Analysis ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Survival Analysis ; Tissue, organ and graft immunology ; Waiting Lists</subject><ispartof>Transplantation proceedings, 2012-09, Vol.44 (7), p.1851-1856</ispartof><rights>Elsevier Inc.</rights><rights>2012 Elsevier Inc.</rights><rights>2014 INIST-CNRS</rights><rights>Copyright © 2012 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c465t-1e18a7a4507eaf7d11b5fc890ebe1c55fcf86c3fa3c14025c6c81a35c2188abc3</citedby><cites>FETCH-LOGICAL-c465t-1e18a7a4507eaf7d11b5fc890ebe1c55fcf86c3fa3c14025c6c81a35c2188abc3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>310,311,315,786,790,795,796,23958,23959,25170,27957,27958</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=26647130$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22974854$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Avolio, A.W</creatorcontrib><creatorcontrib>Siciliano, M</creatorcontrib><creatorcontrib>Barone, M</creatorcontrib><creatorcontrib>Lai, Q</creatorcontrib><creatorcontrib>Caracciolo, G.L</creatorcontrib><creatorcontrib>Barbarino, R</creatorcontrib><creatorcontrib>Nicolotti, N</creatorcontrib><creatorcontrib>Lirosi, M.C</creatorcontrib><creatorcontrib>Gasbarrini, A</creatorcontrib><creatorcontrib>Agnes, S</creatorcontrib><title>Model for End-stage Liver Disease Dynamic Stratification of Survival Benefit</title><title>Transplantation proceedings</title><addtitle>Transplant Proc</addtitle><description>Abstract Only patients with Model for End-stage Liver Disease (MELD) scores ≥18 or ≥17 experience a survival benefit (SB) at 12 and 36 months after liver transplantation (OLT). The SB calculation estimates the difference after stratification for risk categories between the survival rate of transplanted versus waiting list patients. The aim of this study was to perform a short- and long-term (60 months) SB analyses of a Italian OLT program. One-hundred seventy-one patients were stratified into four MELD classes (6–14, 15–18, 19–25, 26–40), and two groups: namely, waiting list (WL) and transplanted groups (TX). The median waiting time for transplanted patients was 4.4 months (range, 0–35). SB was expressed as mortality hazard ratio (MHR) as obtained through a Cox regression analysis using as a covariate the status of each patient in the waiting list (WL = 0, reference group) or the TX group (TX = 1). Values over 1 indicated the MHR in favor of the WL with the values below 1 indicating MHR in favor of Tx. In the MELD class 6 to 14, the MHR was above 1 at 3 and 6 months, indicating an SB in favor of WL; subsequently, the MHR dropped below 1, indicating an SB in favor of TX ( P < .05). In the MELD class 15 to 18 the MHR was above 1 at 3 months, but below 1 subsequently ( P < .05). For MELD classes 19 to 25 and 26 to 40, the MHR was always below 1 ( P < .01). According to the SB approach, patients in the MELD class 6 to 14 could safely wait for at least 36 months; patients in the MELD class 15 to 18 should likely remain no longer than 12 months on the waiting list, and all the remaining patients with MELD > 18 should be transplanted as soon as possible. OLT should not be precluded but only postponed for MELD < 19 patients.</description><subject>Adult</subject><subject>Biological and medical sciences</subject><subject>End Stage Liver Disease - surgery</subject><subject>Female</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Health Care Rationing</subject><subject>Humans</subject><subject>Italy</subject><subject>Liver Transplantation</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Other diseases. Semiology</subject><subject>Regression Analysis</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Survival Analysis</subject><subject>Tissue, organ and graft immunology</subject><subject>Waiting Lists</subject><issn>0041-1345</issn><issn>1873-2623</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><recordid>eNqNkV2LEzEUhoMobl39CzIIgjdTc_I1GS8E3a4fUPGieh3SMyeSOp1Zk5lC_70p7aJ45U0-yHPeE57D2AvgS-BgXu-WU_JDvksjEnVLwUEsuVlybR6wBdhG1sII-ZAtOFdQg1T6ij3JecfLXSj5mF0J0TbKarVg6y9jR30VxlTdDl2dJ_-DqnU8UKpWMZPPVK2Og99HrDal6xRDxLKOQzWGajOnQzz4vnpPA4U4PWWPgu8zPbvs1-z7h9tvN5_q9dePn2_erWtURk81EFjfeKV5Qz40HcBWB7Qtpy0B6nIO1qAMXiIoLjQatOClRgHW-i3Ka_bqnFsU_JopT24fM1Lf-4HGOTvgsrVWtU1T0DdnFNOYc6Lg7lLc-3QskDvZdDv3t013sum4ccVmKX5-6TNv9-XtvvReXwFeXgCf0fehBGHMfzhjVAOSF2515qhYOURKLmOkAamLiXBy3Rj_7z9v_4nBPg5lIP1POlLejXMaincHLpcatznN_zR-EJzrtlXyN-4UruY</recordid><startdate>20120901</startdate><enddate>20120901</enddate><creator>Avolio, A.W</creator><creator>Siciliano, M</creator><creator>Barone, M</creator><creator>Lai, Q</creator><creator>Caracciolo, G.L</creator><creator>Barbarino, R</creator><creator>Nicolotti, N</creator><creator>Lirosi, M.C</creator><creator>Gasbarrini, A</creator><creator>Agnes, S</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20120901</creationdate><title>Model for End-stage Liver Disease Dynamic Stratification of Survival Benefit</title><author>Avolio, A.W ; Siciliano, M ; Barone, M ; Lai, Q ; Caracciolo, G.L ; Barbarino, R ; Nicolotti, N ; Lirosi, M.C ; Gasbarrini, A ; Agnes, S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c465t-1e18a7a4507eaf7d11b5fc890ebe1c55fcf86c3fa3c14025c6c81a35c2188abc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Adult</topic><topic>Biological and medical sciences</topic><topic>End Stage Liver Disease - surgery</topic><topic>Female</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Fundamental immunology</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Health Care Rationing</topic><topic>Humans</topic><topic>Italy</topic><topic>Liver Transplantation</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Other diseases. Semiology</topic><topic>Regression Analysis</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Survival Analysis</topic><topic>Tissue, organ and graft immunology</topic><topic>Waiting Lists</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Avolio, A.W</creatorcontrib><creatorcontrib>Siciliano, M</creatorcontrib><creatorcontrib>Barone, M</creatorcontrib><creatorcontrib>Lai, Q</creatorcontrib><creatorcontrib>Caracciolo, G.L</creatorcontrib><creatorcontrib>Barbarino, R</creatorcontrib><creatorcontrib>Nicolotti, N</creatorcontrib><creatorcontrib>Lirosi, M.C</creatorcontrib><creatorcontrib>Gasbarrini, A</creatorcontrib><creatorcontrib>Agnes, S</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Transplantation proceedings</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Avolio, A.W</au><au>Siciliano, M</au><au>Barone, M</au><au>Lai, Q</au><au>Caracciolo, G.L</au><au>Barbarino, R</au><au>Nicolotti, N</au><au>Lirosi, M.C</au><au>Gasbarrini, A</au><au>Agnes, S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Model for End-stage Liver Disease Dynamic Stratification of Survival Benefit</atitle><jtitle>Transplantation proceedings</jtitle><addtitle>Transplant Proc</addtitle><date>2012-09-01</date><risdate>2012</risdate><volume>44</volume><issue>7</issue><spage>1851</spage><epage>1856</epage><pages>1851-1856</pages><issn>0041-1345</issn><eissn>1873-2623</eissn><coden>TRPPA8</coden><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Abstract Only patients with Model for End-stage Liver Disease (MELD) scores ≥18 or ≥17 experience a survival benefit (SB) at 12 and 36 months after liver transplantation (OLT). The SB calculation estimates the difference after stratification for risk categories between the survival rate of transplanted versus waiting list patients. The aim of this study was to perform a short- and long-term (60 months) SB analyses of a Italian OLT program. One-hundred seventy-one patients were stratified into four MELD classes (6–14, 15–18, 19–25, 26–40), and two groups: namely, waiting list (WL) and transplanted groups (TX). The median waiting time for transplanted patients was 4.4 months (range, 0–35). SB was expressed as mortality hazard ratio (MHR) as obtained through a Cox regression analysis using as a covariate the status of each patient in the waiting list (WL = 0, reference group) or the TX group (TX = 1). Values over 1 indicated the MHR in favor of the WL with the values below 1 indicating MHR in favor of Tx. In the MELD class 6 to 14, the MHR was above 1 at 3 and 6 months, indicating an SB in favor of WL; subsequently, the MHR dropped below 1, indicating an SB in favor of TX ( P < .05). In the MELD class 15 to 18 the MHR was above 1 at 3 months, but below 1 subsequently ( P < .05). For MELD classes 19 to 25 and 26 to 40, the MHR was always below 1 ( P < .01). According to the SB approach, patients in the MELD class 6 to 14 could safely wait for at least 36 months; patients in the MELD class 15 to 18 should likely remain no longer than 12 months on the waiting list, and all the remaining patients with MELD > 18 should be transplanted as soon as possible. OLT should not be precluded but only postponed for MELD < 19 patients.</abstract><cop>Amsterdam</cop><pub>Elsevier Inc</pub><pmid>22974854</pmid><doi>10.1016/j.transproceed.2012.06.056</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Biological and medical sciences End Stage Liver Disease - surgery Female Fundamental and applied biological sciences. Psychology Fundamental immunology Gastroenterology. Liver. Pancreas. Abdomen Health Care Rationing Humans Italy Liver Transplantation Liver. Biliary tract. Portal circulation. Exocrine pancreas Male Medical sciences Middle Aged Other diseases. Semiology Regression Analysis Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Survival Analysis Tissue, organ and graft immunology Waiting Lists |
| title | Model for End-stage Liver Disease Dynamic Stratification of Survival Benefit |
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