Standardizing MELD Exceptions: Current Challenges and Future Directions.
Standardizing MELD Exceptions: Current Challenges and Future Directions.
复制标题
标准化 MELD 例外：当前挑战和未来方向。
DOI：
10.1007/s40472-014-0027-4
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发表时间：
2014
影响因子：
2.1
通讯作者：
Olthoff,KimM
中科院分区：
文献类型：
--
作者：
Goldberg,DavidS;Olthoff,KimM
自2002年实施基于终末期肝病模型（MELD）的分配以来，一个例外积分系统已经到位，以便给予那些疾病严重程度或并发症风险未被MELD评分反映的患者更多的等候名单优先权。这些例外分为标准化和非标准化，随着时间的推移，它们的使用频率越来越高。对例外点制度的若干挑战已经出现，包括用于批准此类例外的标准缺乏标准化，使用和批准此类例外的地域差异，以及支持某些例外的证据基础有限。在此，我们总结了异常点的实施现状，移植界面临的挑战，以及完善和规范当前异常点制度的建议。
Since Model for End-Stage Liver Disease (MELD)-based allocation was implemented in 2002, a system of exception points has been in place in order to award increased waitlist priority to those patients whose severity of illness or risk of complications are not captured by the MELD score. These exceptions, categorized as standardized and non-standardized, have been used with increasing frequency over time. Several challenges to the exception point system have emerged, including lack of standardization in the criteria used to approve such exceptions, geographic variability in the use and approval of such exceptions, and a limited evidence base to support certain exceptions. Herein, we summarize the current implementation of exception points, the challenges facing the transplant community, and suggestions for improving and standardizing the current exception point system.