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, Nicola Nicolotti, M Salizzoni, L De Carlis, M Colledan, Ge Gerunda, V Mazzaferro, G Tisone, R Romagnoli, L Caccamo, M Rossi, A Vitale, A Cucchetti, L Lupo, S Gruttadauria, P Burra

Risultato della ricerca: Contributo in rivistaArticolo in rivistapeer review

Abstract

Donor–recipient match is a matter of debate in liver transplantation. D-MELD (donor age × recipient bio- chemical model for end-stage liver disease [MELD]) and other factors were analyzed on a national Ital- ian 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 in- vestigated. 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% cutoff was identified only in HCV patients (D-MELD ≥ 1750). The innovative ap- proach offered by D-MELD and covariates is helpful in predicting outcome after liver transplantation, espe- cially in HCV recipients.
Lingua originaleEnglish
pagine (da-a)2724-2736
Numero di pagine13
RivistaAmerican Journal of Transplantation
Volume2011
Stato di pubblicazionePubblicato - 2011

Keywords

  • D-MELD
  • DONOR-RECIPIENT MATCH
  • HEPATITIS C
  • LIVER TRANSPLANTATION
  • Models, Statistical
  • OUTCOME
  • PROGNOSTIC INDICES
  • UNSUSTAINABLE MATCH

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