HEPATOCELLULAR CARCINOMA PATIENTS ARE ADVANTAGED IN THE CURRENT BRAZILIAN LIVER TRANSPLANT ALLOCATION SYSTEM. A COMPETING RISK ANALYSIS

In Brazil, the Model for End-Stage Liver Disease (MELD) score is used to prioritize patients for deceased donor liver transplantation (DDLT). Patients with hepatocellular carcinoma (HCC) receive standardized MELD exception points to account for their cancer risk of mortality, which is not reflected...

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Bibliographic Details
Published in:Arquivos de gastroenterologia 2020-02, Vol.57 (1), p.19-23
Main Authors: Rodríguez, Santiago, Fleck, Jr, Alfeu de Medeiros, Mucenic, Marcos, Marroni, Cláudio, Brandão, Ajacio
Format: Article
Language:English
Subjects:
GASTROENTEROLOGY & HEPATOLOGY
Healthcare disparities
Hepatocellular carcinoma
Liver transplantation
Organ transplantation
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Summary:In Brazil, the Model for End-Stage Liver Disease (MELD) score is used to prioritize patients for deceased donor liver transplantation (DDLT). Patients with hepatocellular carcinoma (HCC) receive standardized MELD exception points to account for their cancer risk of mortality, which is not reflected by their MELD score. To compare DDLT rates between patients with and without HCC in Rio Grande do Sul, the Southernmost state of Brazil. - We retrospectively studied 825 patients on the liver-transplant waiting list from January 1, 2007, to December 31, 2016, in a transplant center located in Porto Alegre, the capital of Rio Grande do Sul, to compare DDLT rates between those with and without HCC. The time-varying hazard of waiting list/DDLT was estimated, reporting the subhazard ratio (SHR) of waiting list/DDLT/dropout with 95% confidence intervals (CI). The final competing risk model was adjusted for age, MELD score, exception points, and ABO group. Patients with HCC underwent a transplant almost three times faster than patients with a calculated MELD score (SHR 2.64; 95% CI 2.10-3.31; P
ISSN:0004-2803
1678-4219
1678-4219
DOI:10.1590/S0004-2803.202000000-05