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

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Francoz, Claire Belghiti, Jacques Castaing, Denis Chazouillères, Olivier Duclos-Vallée, Jean-Charles Lerut, Jan [UCL] Durand, François

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.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès restreint
Publication date 2011
Language Anglais
Journal information "Liver Transplantation" - Vol. 17, no. 10, p. 1137-1151 (2011)
Peer reviewed yes
Publisher JohnWiley & Sons, Inc. (Hoboken)
issn 1527-6465
e-issn 1527-6473
Publication status Publié
Affiliations UCL - (SLuc) Service de chirurgie et transplantation abdominale
UCL - SSS/IREC/CHEX - Pôle de chirgurgie expérimentale et transplantation
MESH Subject Consensus Development Conferences as Topic ; Decision Support Techniques ; Time Factors ; Tissue Donors - supply & distribution ; Tissue and Organ Procurement ; Treatment Outcome ; Waiting Lists ; End Stage Liver Disease - diagnosis, mortality, surgery ; France ; Health Status Indicators ; Humans ; Liver Transplantation - adverse effects, mortality ; Patient Selection ; Risk Assessment ; Risk Factors
Links
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Bibliographic reference Francoz, Claire ; Belghiti, Jacques ; Castaing, Denis ; Chazouillères, Olivier ; Duclos-Vallée, Jean-Charles ; et. al. Model for end-stage liver disease exceptions in the context of the French model for end-stage liver disease score-based liver allocation system. In: Liver Transplantation, Vol. 17, no. 10, p. 1137-1151 (2011)
Permanent URL http://hdl.handle.net/2078.1/110026