Date on Master's Thesis/Doctoral Dissertation

12-2015

Document Type

Master's Thesis

Degree Name

M.S.

Department

Bioinformatics and Biostatistics

Degree Program

Biostatistics, MS

Committee Chair

Brock, Guy

Committee Member

Marvin, Michael

Committee Member

Lorenz, Douglas

Committee Member

Kong, Maiying

Author's Keywords

HCC; Liver Transplantation; Multistate Models; MELD

Abstract

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.

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