{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T18:51:59Z","timestamp":1789671119830,"version":"4.0.1"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","license":[{"start":{"date-parts":[[2017,9,22]],"date-time":"2017-09-22T00:00:00Z","timestamp":1506038400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"},{"start":{"date-parts":[[2017,9,22]],"date-time":"2017-09-22T00:00:00Z","timestamp":1506038400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:p>\n                    The sickest\u2010first principle in donor\u2010liver allocation can be implemented by allocating organs to patients with cirrhosis with the highest Model for End\u2010Stage Liver Disease (MELD) scores. For patients with other risk factors, standard exceptions (SEs) and nonstandard exceptions (NSEs) have been developed. We investigated whether this system of matched MELD scores achieves similar outcomes on the liver transplant waiting list for various diagnostic groups in Eurotransplant (ET) countries with MELD\u2010based individual allocation (Belgium, the Netherlands, and Germany). A retrospective analysis of the ET wait\u2010list outflow from December 2006 until December 2015 was conducted to investigate the relation of the unified MELD\u2010based allocation to the risk of a negative wait\u2010list outcome (death on the waiting list or delisting as too sick) as opposed to a positive wait\u2010list outcome (transplantation or delisting as recovered). A total of 16,926 patients left the waiting list with a positive (11,580) or negative (5346) outcome; 3548 patients had a SE, and 330 had a NSE. A negative outcome was more common among patients without a SE or NSE (34.3%) than among patients with a SE (22.6%) or NSE (18.6%;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    &lt; 0.001). Analysis by model\u2010based recursive partitioning detected 5 risk groups with different relations of matched MELD to a negative outcome. In Germany, we found the following: (1) no SE or NSE, SE for biliary sepsis (BS); (2) SE for hepatocellular carcinoma (HCC), hepatopulmonary syndrome (HPS), or portopulmonary hypertension (PPH); and (3) SE for primary sclerosing cholangitis (PSC) or polycystic liver disease (PcLD). In Belgium and the Netherlands, we found the following: (4) SE or NSE, or SE for HPS or PPH; and (5) SE for BS, HCC, PcLD, or PSC. In conclusion, SEs and NSEs do not even out risks across different diagnostic groups. Patients with SEs or NSEs appear advantaged toward patients with cirrhosis without SEs or NSEs.\n                    <jats:italic toggle=\"yes\">Liver Transplantation 23 1256\u20131265 2017<\/jats:italic>\n                    AASLD.\n                  <\/jats:p>","DOI":"10.1002\/lt.24805","type":"journal-article","created":{"date-parts":[[2017,6,26]],"date-time":"2017-06-26T08:04:40Z","timestamp":1498464280000},"page":"1256-1265","source":"Crossref","is-referenced-by-count":37,"title":["Disparities in Eurotransplant liver transplantation wait\u2010list outcome between patients with and without model for end\u2010stage liver disease exceptions"],"prefix":"10.1097","volume":"23","author":[{"given":"Andreas","family":"Umgelter","sequence":"first","affiliation":[{"name":"2nd Medical Department,Technische Universit\u00e4t M\u00fcnchen,Munich,Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Hapfelmeier","sequence":"additional","affiliation":[{"name":"Institute of Medical Statistics and Epidemiology,Technische Universit\u00e4t M\u00fcnchen,Munich,Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wouter","family":"Kopp","sequence":"additional","affiliation":[{"name":"Eurotransplant International Foundation,Leiden,the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marieke","family":"van Rosmalen","sequence":"additional","affiliation":[{"name":"Eurotransplant International Foundation,Leiden,the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Rogiers","sequence":"additional","affiliation":[{"name":"Department of Surgery,Gent University Hospital Medical School,Gent,Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Guba","sequence":"additional","affiliation":[{"name":"Department of General, Visceral and Transplant Surgery, Gro\u00dfhadern Clinic,University of Munich,Munich,Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Eurotransplant Liver Advisory Committee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2017,9,22]]},"reference":[{"key":"lt24805-bib-0002-20240115","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1053\/jlts.2001.25879","article-title":"MELD and PELD: application of survival models to liver allocation","volume":"7","year":"2001","journal-title":"Liver Transpl"},{"issue":"suppl 3","key":"lt24805-bib-0003-20240115","first-page":"S85","article-title":"Model for End\u2010Stage Liver Disease (MELD) exception guidelines","volume":"12","year":"2006","journal-title":"Liver Transpl"},{"key":"lt24805-bib-0004-20240115","doi-asserted-by":"crossref","first-page":"285","DOI":"10.1002\/hep.27283","article-title":"Excess mortality on the liver transplant waiting list: unintended policy consequences and Model for End\u2010Stage Liver Disease (MELD) inflation","volume":"61","year":"2015","journal-title":"Hepatology"},{"key":"lt24805-bib-0005-20240115","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1007\/s40472-014-0027-4","article-title":"Standardizing MELD exceptions: current challenges and future directions","volume":"1","year":"2014","journal-title":"Curr Transpl Rep"},{"key":"lt24805-bib-0006-20240115","doi-asserted-by":"crossref","first-page":"2362","DOI":"10.1111\/j.1600-6143.2011.03735.x","article-title":"MELD exceptions and rates of waiting list outcomes","volume":"11","year":"2011","journal-title":"Am J Transplant"},{"key":"lt24805-bib-0008-20240115","doi-asserted-by":"crossref","first-page":"1107","DOI":"10.1002\/lt.24449","article-title":"Longterm results of liver transplantation from donation after circulatory death","volume":"22","year":"2016","journal-title":"Liver Transpl"},{"key":"lt24805-bib-0009-20240115","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1198\/106186008X319331","article-title":"Model\u2010based recursive partitioning","volume":"17","year":"2008","journal-title":"J Comput Graph Stat"},{"key":"lt24805-bib-0010-20240115","first-page":"175","article-title":"Organs without borders? allocating transplant organs, foreigners, and the importance of the nation state","volume":"77","year":"2014","journal-title":"Law Contemp Probl"},{"key":"lt24805-bib-0011-20240115","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1016\/j.jhep.2011.05.012","article-title":"Criteria for liver transplantation for HCC: what should the limits be?","volume":"55","year":"2011","journal-title":"J Hepatol"},{"key":"lt24805-bib-0012-20240115","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1111\/liv.12966","article-title":"Excellent post\u2010transplant survival in patients with intermediate stage hepatocellular carcinoma responding to neoadjuvant therapy","volume":"36","year":"2016","journal-title":"Liver Int"},{"key":"lt24805-bib-0013-20240115","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1002\/lt.23587","article-title":"Risk of waitlist mortality in patients with primary sclerosing cholangitis and bacterial cholangitis","volume":"19","year":"2013","journal-title":"Liver Transpl"},{"key":"lt24805-bib-0014-20240115","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1111\/j.1432-2277.2010.01161.x","article-title":"Multicentric evaluation of Model for End\u2010Stage Liver Disease\u2010based allocation and survival after liver transplantation in Germany\u2010\u2010limitations of the \u2018sickest first\u2019\u2010concept","volume":"24","year":"2011","journal-title":"Transpl Int"},{"issue":"pt 2","key":"lt24805-bib-0015-20240115","first-page":"970","article-title":"Survival benefit\u2010based deceased\u2010donor liver allocation","volume":"9","year":"2009","journal-title":"Am J Transplant"},{"key":"lt24805-bib-0016-20240115","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1002\/lt.23780","article-title":"Ethical considerations surrounding survival benefit\u2010based liver allocation","volume":"20","year":"2014","journal-title":"Liver Transpl"},{"key":"lt24805-bib-0017-20240115","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1111\/j.1600-6143.2004.00703.x","article-title":"The survival benefit of liver transplantation","volume":"5","year":"2005","journal-title":"Am J Transplant"},{"key":"lt24805-bib-0019-20240115","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1136\/gut.38.4.610","article-title":"Natural history and prognostic factors in 305 Swedish patients with primary sclerosing cholangitis","volume":"38","year":"1996","journal-title":"Gut"},{"key":"lt24805-bib-0020-20240115","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1002\/hep.1840100406","article-title":"Primary sclerosing cholangitis: natural history, prognostic factors and survival analysis","volume":"10","year":"1989","journal-title":"Hepatology"},{"key":"lt24805-bib-0021-20240115","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1016\/S0025-6196(11)64614-4","article-title":"A revised natural history model for primary sclerosing cholangitis","volume":"75","year":"2000","journal-title":"Mayo Clin Proc"},{"key":"lt24805-bib-0022-20240115","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1186\/1471-230X-11-83","article-title":"The prevalence, incidence and natural history of primary sclerosing cholangitis in an ethnically diverse population","volume":"11","year":"2011","journal-title":"BMC Gastroenterol"}],"container-title":["Liver Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Flt.24805","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/01445473-201710000-00005","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,14]],"date-time":"2024-01-14T20:30:35Z","timestamp":1705264235000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/01445473-201710000-00005"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9,22]]},"references-count":19,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.1002\/lt.24805","relation":{},"ISSN":["1527-6465","1527-6473"],"issn-type":[{"value":"1527-6465","type":"print"},{"value":"1527-6473","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9,22]]}}}