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

Donor–recipient match is a matter of debate in liver\r\ntransplantation. D-MELD (donor age × recipient biochemical\r\nmodel for end-stage liver disease [MELD])\r\nand other factors were analyzed on a national Italian\r\ndatabase recording 5946 liver transplants. Primary\r\nendpoint was to determine factors predictive of 3-\r\nyear patient survival. D-MELD cutoff predictive of 5-\r\nyear patient survival <50% (5yrsPS<50%) was investigated.\r\nA prognosis calculator was implemented\r\n(www.D-MELD.com). Differences among D-MELD\r\ndeciles allowed their regrouping into three D-MELD\r\nclasses (A < 338, B 338–1628, C >1628). At 3 years, the\r\nodds ratio (OR) for death was 2.03 (95% confidence\r\ninterval [CI], 1.44–2.85) in D-MELD class C versus B.\r\nThe OR was 0.40 (95% CI, 0.24–0.66) in class A versus\r\nclass B. Other predictors were hepatitis C virus (HCV;\r\nOR = 1.42; 95% CI, 1.11–1.81), hepatitis B virus (HBV;\r\nOR = 0.69; 95% CI, 0.51–0.93), retransplant (OR = 1.82;\r\n95% CI, 1.16–2.87) and low-volume center (OR = 1.48;\r\n95% CI, 1.11–1.99). Cox regressions up to 90 months\r\nconfirmed results. The hazard ratio was 1.97 (95% CI,\r\n1.59–2.43) for D-MELD class C versus class B and 0.42\r\n(95% CI, 0.29–0.60) for D-MELD class A versus class\r\nB. Recipient age, HCV, HBV and retransplant were also\r\nsignificant. The 5yrsPS<50% cutoffwas identified only\r\nin HCV patients (D-MELD ≥ 1750). The innovative approach\r\noffered by D-MELD and covariates is helpful in\r\npredicting outcome after liver transplantation, especially\r\nin HCV recipients.