Toward a better liver graft allocation that accounts for candidates with and without hepatocellular carcinoma

Toso, Christian; Mazzaferro, V; Bruix, J; Freeman, R; Mentha, Gilles; Majno, Pietro

doi:10.1111/ajt.12923

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Title		Toward a better liver graft allocation that accounts for candidates with and without hepatocellular carcinoma
Authors		Toso, Christian Mazzaferro, V Bruix, J Freeman, R Mentha, Gilles Majno, Pietro
Published in		American Journal of Transplantation. 2014, vol. 14, no. 10, p. 2221-7
Abstract		In some countries where the Model for End-Stage Liver Disease (MELD) score is used for graft allocation, selected patients with hepatocellular carcinoma (HCC) receive a fixed number of exception points at listing, and increasing priority on the list by accruing additional exception points at regular time intervals. This system originally aimed at balancing the risks of HCC patients of developing contraindications and of non-HCC patients of dying before transplantation, is not ideal because it appears to offer an advantage to HCC patients, regardless of tumor characteristics and response to loco-regional treatment. Scores modulated by HCC characteristics have been proposed. They are based on a more refined estimate of the risk of pretransplant drop-out or of the posttransplant transplant benefit expressed as the life-years gained for each graft. This review describes the newly proposed systems, and discusses their advantages and drawbacks. We believe that the current exception points allocation should be revised and that drop-out-equivalent or transplant benefit-equivalent models should be studied further. As with all policy changes, these should be done under close monitoring that allows subsequent revisions.
Identifiers		DOI: 10.1111/ajt.12923 PMID: 25220672
Full text		Article (Published version) (107 Kb) - Limited access to UNIGE
Structures		Faculté de médecine / Section de médecine clinique / Département de chirurgie
Research groups		Transplantation et hépatologie (905) Hépatologie chirurgicale (327)
Citation (ISO format)		TOSO, Christian et al. Toward a better liver graft allocation that accounts for candidates with and without hepatocellular carcinoma. In: American Journal of Transplantation, 2014, vol. 14, n° 10, p. 2221-7. doi: 10.1111/ajt.12923 https://archive-ouverte.unige.ch/unige:40986