TY - JOUR
T1 - Balancing donor and recipient risk factors in liver transplantation: the value of D-MELD with particular reference to HCV patients.
AU - Avolio, Alfonso Wolfango
AU - Cillo, Umberto
AU - Salizzoni, Mauro
AU - De Carlis, Luciano
AU - Colledan, Michele
AU - Gerunda, Giorgio Enrico
AU - Mazzaferro, Vincenzo
AU - Tisone, Giuseppe
AU - Romagnoli, Renato
AU - Caccamo, Lucio
AU - Rossi, Massimo
AU - Vitale, Alessandro
AU - Cucchetti, M
AU - Lupo, Luigi
AU - Gruttadauria, Salvatore
AU - Nicolotti, Nicola
AU - Burra, Patrizia
AU - Gasbarrini, Antonio
AU - Agnes, Salvatore
PY - 2011
Y1 - 2011
N2 - 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.
AB - 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.
KW - D-MELD
KW - HCV
KW - Liver transplantation
KW - MELD
KW - allocation
KW - donor to recipient match
KW - outcome
KW - risk factors
KW - survival
KW - D-MELD
KW - HCV
KW - Liver transplantation
KW - MELD
KW - allocation
KW - donor to recipient match
KW - outcome
KW - risk factors
KW - survival
UR - http://hdl.handle.net/10807/18251
UR - http://www.amjtrans.com
M3 - Article
SN - 1600-6135
VL - 11
SP - 2724
EP - 2736
JO - American Journal of Transplantation
JF - American Journal of Transplantation
ER -