Comparison of two equivalent model for end‐stage liver disease scores for hepatocellular carcinoma patients using data from the United Network for Organ Sharing liver transplant waiting list registry

摘要

Summary Patients with hepatocellular carcinoma ( HCC ) have been advantaged on the liver transplant waiting list within the United States, and a 6‐month delay and exception point cap have recently been implemented to address this disparity. An alternative approach to prioritization is an HCC ‐specific scoring model such as the MELD Equivalent ( MELD EQ ) and the mixed new de MELD . Using data on adult patients added to the UNOS waitlist between 30 September 2009 and 30 June 2014, we compared projected dropout and transplant probabilities for patients with HCC under these two models. Both scores matched actual non‐ HCC dropout in groups with scores 22 and improved equity with non‐ HCC transplant probabilities overall. However, neither score matched non‐ HCC dropout accurately for scores of 25–40 and projected dropout increased beyond non‐ HCC probabilities for scores 16. The main differences between the two scores were as follows: (i) the MELD EQ assigns 6.85 more points after 6 months on the waitlist and (ii) the de MELD gives greater weight to tumor size and laboratory MELD . Post‐transplant survival was lower for patients with scores in the 22–30 range compared with those with scores 16 ( P = 0.007, MELD EQ ; P = 0.015, de MELD ). While both scores result in better equity of waitlist outcomes compared with scheduled progression, continued development and calibration is recommended.