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Presenter: Michael, Fink, Melbourne, Australia
Authors: Michael A Fink, Graham Starkey, Bao-Zhong Wang, Peter W Angus, Paul J Gow, Adam G Testro, Robert M Jones
Validation of risk models for allocation by survival benefit in liver transplantation
Michael A Fink1,2, Graham Starkey2, Bao-Zhong Wang2, Peter W Angus2, Paul J Gow2, Adam G Testro2, Robert M Jones1,2
1Department of Surgery, Austin Hospital, The University of Melbourne, Melbourne, Australia, 2Liver Transplant Unit, Austin Hospital, Melbourne, Australia
The imbalance between demand for and supply of organs makes rationing of available organs inevitable. Appropriate allocation of this limited resource is essential to maximise the clinical impact of transplantation. One approach that has been developed is allocation by survival benefit of transplantation over waiting. The liver transplant models developed by Schaubel et al. [1] were validated in a single centre. The waiting list model was evaluated in patients on the waiting list on 1st January and 1st July each year from 2000 to 2012 (n = 758). The post transplantation recipient and donor models were evaluated in patients transplanted from 1/1/2000 to 31/12/2012 (n = 497). Patients were grouped according to hazard ratio for each model and survival rates were compared using log rank. The waiting list model stratified patient survival on the waiting list (P<0.001) and predicted the survival of low risk patients well, although it did not differentiate well between higher risk patients. The donor risk model stratified post transplantation survival well (P = 0.019). The recipient risk model stratified post transplantation survival (P = 0.004), although the patients predicted to be at greatest risk (HR > 3) in fact had a low risk of post-transplantation graft loss (87% 5-year graft survival). Risk models can enable evaluation of allocation by survival benefit, but continued exploration, refinement and validation of allocation models and estimation of impact on survival is required.
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