Abstract

In many countries, the allocation of liver grafts is based on the Model of End-stage Liver Disease (MELD) score and the use of exception points for patients with hepatocellular carcinoma (HCC). With this strategy, HCC patients have easier access to transplantation than non-HCC ones. In addition, this system does not allow for a dynamic assessment, which would be required to picture the current use of local tumor treatment. This study was based on the Scientific Registry of Transplant Recipients and included 5'498 adult candidates of a liver transplantation for HCC and 43'528 for non-HCC diagnoses. A proportional hazard competitive risk model was used. The risk of drop-out of HCC patients was independently predicted by MELD score, HCC size, HCC number and alpha fetoprotein (AFP). When combined in a model with age and diagnosis, these factors allowed for the extrapolation of the risk of drop-out. While this model and MELD did not share compatible scales, a correlation between both models was computed according to the predicted risk of drop-out, and drop-out equivalent MELD (deMELD) points were calculated. CONCLUSION: The proposed model, with the allocation of deMELD, has the potential to allow for a dynamic and combined comparison of opportunities to receive a graft for HCC and non-HCC patients on a common waiting list. (HEPATOLOGY 2012.).

Copyright © 2012 American Association for the Study of Liver Diseases.