Evaluation of liver transplant prioritization methods for hepatocellular carcinoma patients using multistate models [thesis]

Sarah Alver
the opportunity to participate in this research. As well, I thank Dr. Brock for his teaching and willingness to share his ideas and enthusiasm. I have learned a great deal from this project and could not have done so without his guidance and patience. Additionally, I thank my husband John and my son Gabriel for their help and understanding during the past two years. I could not have completed this project or this degree if John had not taken on so much more than his share of our
more » ... our responsibilities during this time or if Gabriel were not such a reasonable and good-natured teenager. Finally, I thank my coworkers and friends, Phyllis Spalt and Anna Hartman, for their encouragement and support. iv The Model for End Stage Liver Disease (MELD), used for prioritizing liver transplantation, predicts mortality from liver disease. Patients with hepatocellular carcinoma (HCC) risk disease progression not reflected in their MELD score. Exception scores prioritize HCC patients higher than their MELD scores, but advantage them over non-HCC patients. To address this, a delay of six months for using exception scores has been implemented, and alternative HCC-specific scores have been developed. Using multistate models, this study projects waitlist dropout and transplant probabilities under the delay and under two alternative scores. The delay improves equity between HCC and non-HCC patients for the first six months waitlist time, but still advantages HCC patients after six months. Both alternative scores would improve this inequity but increase dropout for some HCC risk groups and decrease HCC transplant probabilities below non-HCC probabilities. Further calibration of these scores is recommended prior to considering them for implementation. v
doi:10.18297/etd/2331 fatcat:4c5fgdj36zbhhf3ywrwpkjarfi