Median Meld at Transplant Minus 3 Reduces the Mortality of Non-Hepatocellular Carcinoma Patients on the Liver Transplant Waitlist
Liver transplants (LTs) are prioritized by mortality risk, which is estimated by MELD scores. Since hepatocellular carcinoma (HCC) patients present with lower MELD scores, they are allocated MELD exception points. Concerns persist that HCC recipients are over-prioritized, resulting in disproportiona...
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MDPI AG
2024-11-01
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| Series: | Current Oncology |
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| author | Panthea Pouramin Susan E. Allen Joseph L. Silburt Boris L. Gala-Lopez |
| author_facet | Panthea Pouramin Susan E. Allen Joseph L. Silburt Boris L. Gala-Lopez |
| author_sort | Panthea Pouramin |
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| description | Liver transplants (LTs) are prioritized by mortality risk, which is estimated by MELD scores. Since hepatocellular carcinoma (HCC) patients present with lower MELD scores, they are allocated MELD exception points. Concerns persist that HCC recipients are over-prioritized, resulting in disproportionate waitlist mortality among non-HCC patients. We assessed whether the Median Meld at Transplant minus 3 (MMaT-3) scoring system would balance waitlist mortality and transplantation rates between HCC and non-HCC patients. We reviewed 266 patient charts listed for an LT from 2015 to 2023; 46.2% were listed in the MMaT-3 era. Amongst non-HCC patients, MMaT-3 implementation significantly increased 1-year transplant rate and reduced 1-year waitlist mortality among non-HCC patients (<i>p</i> = 0.003). Pre-MMaT-3 gaps in transplantation (<i>p</i> = 0.004) and waitlist dropout (<i>p</i> = 0.01) were eliminated post-implementation (<i>p</i> > 0.05). Amongst HCC patients, MMaT-3 implementation had no impact on the 1-year transplant rate (<i>p</i> = 0.92) or 1-year waitlist mortality (<i>p</i> = 0.66). Fine-gray proportional hazard multivariable analysis revealed that MMaT-3 significantly reduced waitlist mortality among non-HCC patients (asHR: 0.44, 95% CI [0.23, 0.83], <i>p</i> = 0.01) and limited impact on HCC patients (<i>p</i> = 0.31). MMaT-3 allocation did not significantly alter 2-year post-transplant survival for both populations. We show that the MMaT-3 system decreased the waitlist mortality of non-HCC patients with limited impacts on outcomes for HCC patients listed for an LT. |
| format | Article |
| id | doaj-art-32e9bbf6c5294334be3a3cf6bac8edc8 |
| institution | Kabale University |
| issn | 1198-0052 1718-7729 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | MDPI AG |
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| series | Current Oncology |
| spelling | doaj-art-32e9bbf6c5294334be3a3cf6bac8edc82024-11-26T17:58:59ZengMDPI AGCurrent Oncology1198-00521718-77292024-11-0131117051706010.3390/curroncol31110519Median Meld at Transplant Minus 3 Reduces the Mortality of Non-Hepatocellular Carcinoma Patients on the Liver Transplant WaitlistPanthea Pouramin0Susan E. Allen1Joseph L. Silburt2Boris L. Gala-Lopez3Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, CanadaMulti-Organ Transplant Program, Department of Surgery, Dalhousie University, Halifax, NS B3H 4R2, CanadaFaculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, CanadaMulti-Organ Transplant Program, Department of Surgery, Dalhousie University, Halifax, NS B3H 4R2, CanadaLiver transplants (LTs) are prioritized by mortality risk, which is estimated by MELD scores. Since hepatocellular carcinoma (HCC) patients present with lower MELD scores, they are allocated MELD exception points. Concerns persist that HCC recipients are over-prioritized, resulting in disproportionate waitlist mortality among non-HCC patients. We assessed whether the Median Meld at Transplant minus 3 (MMaT-3) scoring system would balance waitlist mortality and transplantation rates between HCC and non-HCC patients. We reviewed 266 patient charts listed for an LT from 2015 to 2023; 46.2% were listed in the MMaT-3 era. Amongst non-HCC patients, MMaT-3 implementation significantly increased 1-year transplant rate and reduced 1-year waitlist mortality among non-HCC patients (<i>p</i> = 0.003). Pre-MMaT-3 gaps in transplantation (<i>p</i> = 0.004) and waitlist dropout (<i>p</i> = 0.01) were eliminated post-implementation (<i>p</i> > 0.05). Amongst HCC patients, MMaT-3 implementation had no impact on the 1-year transplant rate (<i>p</i> = 0.92) or 1-year waitlist mortality (<i>p</i> = 0.66). Fine-gray proportional hazard multivariable analysis revealed that MMaT-3 significantly reduced waitlist mortality among non-HCC patients (asHR: 0.44, 95% CI [0.23, 0.83], <i>p</i> = 0.01) and limited impact on HCC patients (<i>p</i> = 0.31). MMaT-3 allocation did not significantly alter 2-year post-transplant survival for both populations. We show that the MMaT-3 system decreased the waitlist mortality of non-HCC patients with limited impacts on outcomes for HCC patients listed for an LT.https://www.mdpi.com/1718-7729/31/11/519liver transplanthepatocellular carcinomaliver allocationwaitlist mortalityMELD scoreMMaT-3 |
| spellingShingle | Panthea Pouramin Susan E. Allen Joseph L. Silburt Boris L. Gala-Lopez Median Meld at Transplant Minus 3 Reduces the Mortality of Non-Hepatocellular Carcinoma Patients on the Liver Transplant Waitlist Current Oncology liver transplant hepatocellular carcinoma liver allocation waitlist mortality MELD score MMaT-3 |
| title | Median Meld at Transplant Minus 3 Reduces the Mortality of Non-Hepatocellular Carcinoma Patients on the Liver Transplant Waitlist |
| title_full | Median Meld at Transplant Minus 3 Reduces the Mortality of Non-Hepatocellular Carcinoma Patients on the Liver Transplant Waitlist |
| title_fullStr | Median Meld at Transplant Minus 3 Reduces the Mortality of Non-Hepatocellular Carcinoma Patients on the Liver Transplant Waitlist |
| title_full_unstemmed | Median Meld at Transplant Minus 3 Reduces the Mortality of Non-Hepatocellular Carcinoma Patients on the Liver Transplant Waitlist |
| title_short | Median Meld at Transplant Minus 3 Reduces the Mortality of Non-Hepatocellular Carcinoma Patients on the Liver Transplant Waitlist |
| title_sort | median meld at transplant minus 3 reduces the mortality of non hepatocellular carcinoma patients on the liver transplant waitlist |
| topic | liver transplant hepatocellular carcinoma liver allocation waitlist mortality MELD score MMaT-3 |
| url | https://www.mdpi.com/1718-7729/31/11/519 |
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