Model for end-stage liver disease exceptions in the context of the French model for end-stage liver disease score-based liver allocation system.

Abstract

Model for End-Stage Liver Disease (MELD) score-based allocation systems have been adopted by most countries in Europe and North America. Indeed, the MELD score is a robust marker of early mortality for patients with cirrhosis. Except for extreme values, high pretransplant MELD scores do not significantly affect posttransplant survival. The MELD score can be used to optimize the allocation of allografts according to a sickest first policy. Most often, patients with small hepatocellular carcinomas (HCCs) and low MELD scores receive extra points, which allow them appropriate access to transplantation comparable to the access of patients with advanced cirrhosis and high MELD scores. In addition to patients with advanced cirrhosis and HCC, patients with a number of relatively uncommon conditions have low MELD scores and a poor prognosis in the short term without transplantation but derive excellent benefits from transplantation. These conditions, which correspond to the so-called MELD score exceptions, justify the allocation of a specific score for appropriate access to transplantation. Here we report the conclusions of the French consensus meeting. The goals of this meeting were (1) to identify which conditions merit MELD score exceptions, (2) to list the criteria needed for defining each of these conditions, and (3) to define a reasonable time interval for organ allocation for each MELD exception in the general context of organ shortages. MELD exceptions were discussed in an attempt to reconcile the concepts of transparency, equity, justice, and utility.

• Authors: Claire Francoz, Jacques Belghiti, Denis Castaing, Olivier Chazouillères, Jean-Charles Duclos-Vallée, Christophe Duvoux, Jan Lerut, Yves-Patrice Le Treut, Richard Moreau, Ameet Mandot, Georges Pageaux, Didier Samuel, Dominique Thabut, Dominique Valla, François Durand
• Journal: Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society (Liver Transpl) Vol. 17 Issue 10 Pg. 1137-51 (Oct 2011) ISSN: 1527-6473 [Electronic] United States
• PMID: 21695771 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2011 American Association for the Study of Liver Diseases.

Topics

• Consensus Development Conferences as Topic
• Decision Support Techniques
• End Stage Liver Disease (diagnosis, mortality, surgery)
• France
• Health Status Indicators
• Humans
• Liver Transplantation (adverse effects, mortality)
• Patient Selection
• Risk Assessment
• Risk Factors
• Time Factors
• Tissue Donors (supply & distribution)
• Tissue and Organ Procurement
• Treatment Outcome
• Waiting Lists