MELD-Based Allocation Policy Beneficial in HCC

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[B]MELD-Based Allocation Policy Beneficial in Hepatocellular Carcinoma[/B]
Laurie Barclay, MD

Jan. 7, 2004 - The new allocation policy based on the model for end-stage
liver disease (MELD) has been beneficial for patients with hepatocellular
carcinoma (HCC), according to the results of a review of the United Network
for Organ Sharing (UNOS) database published in the January issue of Liver
Transplantation.

"The new MELD-based allocation policy has benefited HCC candidates," write
Pratima Sharma, MD, from the Mayo Clinic in Scottsdale, Arizona, and
colleagues. "Significantly higher proportions of candidates listed with the
diagnosis of HCC are receiving a deceased donor liver transplant in the new
MELD-based allocation system."

Between July 1999 and July 2002, 2,074 patients with stage T1 or T2 HCC were
on the waiting list for a deceased donor liver transplant (DDLT). Based on
the listing date, they were divided into two groups: pre- or post-MELD
allocation policy, which was implemented on Feb. 27, 2002.

Compared with the pre-MELD group, the transplant rate more than tripled in
the post-MELD group (0.439 vs. 1.454 transplant/person-years; P < .001), the
time to transplantation decreased from 2.28 years to less than 0.69 years (P
< .001), the five-month dropout rate was cut nearly in half (16.5% vs. 8.5%;
P < .001), and the five-month waiting list survival increased from 90.3% to
95.7% (P < .001).

Within three months of being listed, more than 87% of HCC patients had
received a transplant, suggesting that HCC candidates might have been given
priority to the detriment of patients with cirrhosis of other etiologies.

To address these concerns, UNOS and the Organ Procurement and
Transplantation Network had a consensus meeting in January 2003 and slightly
modified the MELD-based policy. The effects of the new changes have not yet
been determined.

"reliminary indications are that the new allocation system based on MELD
has a favorable effect by reducing waiting list mortality while maintaining
excellent early post-transplantation survival for all diagnoses," the
authors write. "However, the marked advantage given to HCC candidates will
need to be addressed further."

Liver Transplant. 2004;10(1):000-000

Reviewed by Gary D. Vogin, MD
http://www.medscape.com/viewarticle/466818