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

Alfonso Wolfango Avolio, Antonio Gasbarrini, Salvatore Agnes, Marianna Rossi, Nicola Nicolotti, U Cillo, M Salizzoni, L De Carlis, M Colledan, Ge Gerunda, V Mazzaferro, G Tisone, R Romagnoli, L Caccamo, A Vitale, A Cucchetti, L Lupo, S Gruttadauria, P Burra

Risultato della ricerca: Contributo in rivistaArticolo in rivista

77 Citazioni (Scopus)

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 (http://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% cutoff was 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.
Lingua originaleEnglish
pagine (da-a)2724-2736
Numero di pagine13
RivistaAmerican Journal of Transplantation
Volume11
DOI
Stato di pubblicazionePubblicato - 2011

Keywords

  • Adult
  • Age Factors
  • Aged
  • Donor Selection
  • End Stage Liver Disease
  • Female
  • Graft Rejection
  • Graft Survival
  • Health Status Indicators
  • Hepacivirus
  • Hepatitis C
  • Humans
  • Italy
  • Liver Transplantation
  • Male
  • Middle Aged
  • Models, Statistical
  • Postoperative Complications
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • Tissue Donors
  • Young Adult

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