Optimization of Donor-Recipient match and identification of the futile match cutoff. A national italian study on liver transplantation.

Alfonso Wolfango Avolio, Salvatore Agnes, Antonio Gasbarrini, Nicola Nicolotti, Chiara De Waure, Maria Carmen Lirosi, Mauro Salizzoni, Antonio Daniele Pinna, Bruno Gridelli, Luciano De Carlis, Michele Colledan, Giorgio Enrico Gerunda, Umberto Valente, Giorgio Rossi, Giuseppe Maria Ettorre, Andrea Risaliti, Vincenzo Mazzaferro, Francesco Bresadola, Massimo Rossi, Giuseppe TisoneFausto Zamboni, Luigi Lupo, Oreste Cuomo, Fulvio Calise, Matteo Donataccio, Alessandro Vitale, Renato Romagnoli, Francesco Lupo, Alessandro Cucchetti, Salvo Gruttadauria, Iacopo Mangoni, Domenico Pinelli, Roberto Montalti, Massimiliano Gelli, Lucio Caccamo, Giovanni Vennarecci, Daniele Nicolini, Enzo Regalia, Umberto Baccarani, Quirino Lai, Tommaso Manzia, Enzo Tondolo, Maria Rendina, Michele Barone, Alessandro Perrella, Maria Romano, Patrizia Burra, Umberto Cillo

Risultato della ricerca: Contributo in rivistaContributo a convegnopeer review

Abstract

Intentional matching of liver transplant donor-recipient risk factors, supported by D-MELD (donor age × biochemical MELD), could offer a new therapeutic strategy with effects on survival. As yet, an extensive stratification of cases according to the futile transplant principle using a continous quantitative parameter has not been performed. To stratify the prognosis according to donor-recipient match and assess the predictive role of D-MELD together with covariates, a database detailing 5946 liver transplants performed in 21 Italian Centers (2002–2009) was analyzed. Primary endpoint was to evaluate the prognostic power of D-MELD and covariates in terms of 3-year patient survival. The futile-transplant cutoff (life-expectancy <50% at 5 years) was investigated. The database was divided into a training and a validation set. The adequacy of fit for both sets was tested using Hosmer-Lemeshow and C-statistics. Cases were stratified in ten D-MELD deciles. Significant differences among D-MELD deciles allowed regrouping them in three D-MELD classes (A <338, B 338–1628, C >1628). D-MELD classes were used for regression analyses. At 3 years, the odds ratio (OR) for death is 2.03 (95% CI 1.44–2.85) in D-MELD class C versus class B (reference). The OR is 0.40 (95% CI 0.24– 0.66) in D-MELD class A versus class B. Other significant covariates were HCV status (OR = 1.42; 95% CI 1.11–1.81), HBV status (OR = 0.69; 95% CI 0.51–0.93), re-transplant status (OR = 1.82; 95% CI 1.16– 2.67) and low-volume transplant Center (OR = 1.48; 95% CI 1.11– 1.99). Results were confirmed by Cox regressions. The “futilematch cutoff” was identified only in HCV patients (D-MELD=1750, p < 0.001).Assuming the same high D-MELD value, an organ from an elderly donor is likely to fail in an old recipient or in an HCV recipient but not in an HBV recipient. The identification of predictive factors (D-MELD class and covariates) and the introduction of the futile cutoff may lead to formulate new organ-allocation policies. The futile matches should be proibited by national allocation rules. Fatal allocation of high-risk organs to high-risk patients should be avoided. Organs from young donors should not be allocated to recipients with a low biochemical MELD without additional risk factors.
Lingua originaleEnglish
pagine (da-a)17-17
Numero di pagine1
RivistaJournal of Hepatology
Volume2011
Stato di pubblicazionePubblicato - 2011
EventoThe International Liver Congress TM 2011 by EASL - Berlino
Durata: 30 mar 20113 apr 2011

Keywords

  • D-MELD
  • Donor recipient match
  • Futile match
  • HCV
  • Liver Transplantation
  • MELD
  • outcome
  • risk factors

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