Manouk de Hooge, Désirée van der Heijde
Disease modification in axial spondyloarthritis - still a controversy?
Current opinion in rheumatology
following introduction algorithm aiming maximise lifeyears gained liver transplantation uk transplant benefit score tbs donor livers redirected younger older patients mortality rate equalised across age range shortterm waiting list mortality reduced understanding agerelated prioritisation challenging especially younger patients clinicians allocating nontbsdirected livers aimed assess agerelated prioritisation within tbs algorithm modelling liver transplantation prioritisation based data uk transplant unit comparing data regions populationbased modelling study serum parameters age liver transplantation assessment patients attending scottish liver transplant unit edinburgh uk december 2002 november 2023 combined representative synthetic data model tbs survival predictions compared according age group 2549 years vs 60 years chronic liver disease severity disease cause models endstage liver disease ukeld uk meld eurotransplant region meld 30 usa used validated comparators liver disease severity 2093 patients chronic liver disease 1808 86 complete datasets liver disease parameters consistent eligibility liver transplant waiting list uk ukeld 49 disease severity assessed ukeld meld meld 30 differ age median ukeld scores 56 patients aged 60 years vs 56 patients aged 2549 years meld scores 16 vs 16 meld 30 scores 18 vs 18 tbs increased advancing age r045 p00001 tbs predicted transplantation patients aged 60 years older would provide twofold greater net benefit 5 years patients aged 2549 years median tbs 1317 iqr 11161436 older patients vs 706 4111095 younger patients p00001 older patients predicted shorter survival without transplantation younger patients 263 days iqr 144473 older patients vs 861 days 4481164 younger patients p00001 similar survival transplantation 1599 days 15631628 vs 1573 days 15251614 p00001 older patients could reach tbs liver offer likely minimum criteria transplantation ukeld 49 whereas many younger patients required highurgent disease ukeld 60 us eurotransplant programmes prioritise according age uk liver allocation algorithm prioritises older patients transplantation predicting advancing age increases benefit liver transplantation restricted followup biases waiting list data might limit accuracy benefit predictions measures beyond overall waiting list mortality required fully capture benefits liver transplantation none