This policy thus could theoretically increase the waiting time for both patients with acute GPCR Compound Library purchase fulminant hepatitis having a 1A status and for patients

with chronic liver disease. Second, these authors found that the MELD score predicted wait list mortality for patients with acetaminophen toxicity in contrast to other studies where the MELD score did not correlate with wait list mortality for status 1 patients registered with acetaminophen toxicity. The authors do not reconcile the differences in these two studies. Third, this analysis dated back to 2001, before the advent of the MELD allocation policy, which began in February 2002. The study also does not take into account the policy revisions that redefine status 1 to 1A and 1B categories in 2005, which occurred during the www.selleckchem.com/Wnt.html study period. Furthermore, the authors did not assess center effect, which has been shown to have a substantial effect on both pre- and posttransplantation survival, particularly in patients with high MELD scores.4 Finally, and most importantly, broader sharing for status 1A patients relative to patients prioritized by MELD may have a more profound effect on reduction of wait list mortality than any change to prior rules for prioritization for organ allocation. In contrast to the author’s conclusion, one might interpret these results to support a change to distribution

policies so that deceased donor livers are offered to patients with the highest MELD score on a regional basis similar to the status 1 patients at the present time rather than changing the allocation sequence that would put patients with a MELD score greater than 40 ahead of status 1 patients. In fact, such a distribution policy change has been developed and put to public comment recently by the OPTN.5 In conclusion, any analysis of the liver transplant waiting selleckchem list

encompassing a significantly long study period is confounded by changes in policy during the period of analysis. In addition, advances in the management of acute liver failure have occurred that may impact survival. The situation is further complicated when both allocation and distribution rules have changed over time and are not taken into account. Nonetheless, it seems intuitive that offering higher priority through an allocation policy change or broader access through a distribution policy change will improve results for a selected group of the most ill-waiting candidates. Because differences in center expertise are likely to be more profound for the sickest patients, it is important that center effect be accounted for in any such analysis. Finally, what is not addressed here is what will happen to other candidates with chronic liver disease on the list if either approach is taken. Further data are required to assess the potential impact of an allocation policy change that is advocated here.