Balancing donor and recipient risk factors in liver transplantation: the value of D-MELD with particular reference to HCV patients.

Alfonso Wolfango Avolio, Antonio Gasbarrini, Salvatore Agnes, Nicola Nicolotti, Umberto Cillo, Mauro Salizzoni, Luciano De Carlis, Michele Colledan, Giorgio Enrico Gerunda, Vincenzo Mazzaferro, Giuseppe Tisone, Renato Romagnoli, Lucio Caccamo, Massimo Rossi, Alessandro Vitale, M Cucchetti, Luigi Lupo, Salvatore Gruttadauria, Patrizia Burra

Research output: Contribution to journalArticlepeer-review

Abstract

Donor–recipient match is a matter of debate in liver transplantation. D-MELD (donor age × recipient biochemical model for end-stage liver disease [MELD]) and other factors were analyzed on a national Italian database recording 5946 liver transplants. Primary endpoint was to determine factors predictive of 3- year patient survival. D-MELD cutoff predictive of 5- year patient survival <50% (5yrsPS<50%) was investigated. A prognosis calculator was implemented (www.D-MELD.com). Differences among D-MELD deciles allowed their regrouping into three D-MELD classes (A < 338, B 338–1628, C >1628). At 3 years, the odds ratio (OR) for death was 2.03 (95% confidence interval [CI], 1.44–2.85) in D-MELD class C versus B. The OR was 0.40 (95% CI, 0.24–0.66) in class A versus class B. Other predictors were hepatitis C virus (HCV; OR = 1.42; 95% CI, 1.11–1.81), hepatitis B virus (HBV; OR = 0.69; 95% CI, 0.51–0.93), retransplant (OR = 1.82; 95% CI, 1.16–2.87) and low-volume center (OR = 1.48; 95% CI, 1.11–1.99). Cox regressions up to 90 months confirmed results. The hazard ratio was 1.97 (95% CI, 1.59–2.43) for D-MELD class C versus class B and 0.42 (95% CI, 0.29–0.60) for D-MELD class A versus class B. Recipient age, HCV, HBV and retransplant were also significant. The 5yrsPS<50% cutoffwas identified only in HCV patients (D-MELD ≥ 1750). The innovative approach offered by D-MELD and covariates is helpful in predicting outcome after liver transplantation, especially in HCV recipients.
Original languageEnglish
Pages (from-to)2724-2736
Number of pages13
JournalAmerican Journal of Transplantation
Volume11
Publication statusPublished - 2011

Keywords

  • D-MELD
  • HCV
  • Liver transplantation
  • MELD
  • allocation
  • donor to recipient match
  • outcome
  • risk factors
  • survival

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