Donor-Model for End-Stage Liver Disease and Donor-Recipient Matching in Liver Transplantation

• Published in: Transplantation proceedings 2011-05, Vol.43 (4), p.974-976
• Main Authors: Vitale, A, Ramirez Morales, R, dalla Bona, E, Scopelliti, M, Zanus, G, Neri, D, d'Amico, F, Gringeri, E, Russo, F, Burra, P, Angeli, P, Cillo, U
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Biological and medical sciences; Body Mass Index; Chronic Disease; Decision Support Techniques; Donor Selection; Fatty Liver - complications; Fatty Liver - diagnostic imaging; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Gastroenterology. Liver. Pancreas. Abdomen; Graft Survival; Health Status Indicators; Hepatitis B - complications; Hepatitis B - diagnosis; Hepatitis C - complications; Hepatitis C - diagnosis; Humans; Italy; Kaplan-Meier Estimate; Liver Diseases - diagnosis; Liver Diseases - surgery; Liver Transplantation - adverse effects; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Logistic Models; Male; Medical sciences; Middle Aged; Other diseases. Semiology; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Time Factors; Tissue Donors - supply & distribution; Tissue, organ and graft immunology; Treatment Outcome; Ultrasonography; Young Adult
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2011.01.138

Abstract Background The product between donor (D) age and recipient (R) Model for End-Stage Liver Disease (MELD) score at the moment of liver transplantation (LT) has been proposed as a potential D-R matching tool to reduce the risk of “futile” LT from using the MELD score as the main allocation tool. The aim of this study was to evaluate the prognostic ability of D-MELD among a cohort of Italian patients already selected for LT on the basis of a D-R matching philosophy. Methods We studied 303 consecutive adult patients undergoing first LT for chronic liver diseases with available D-MELD at the moment of LT from 2003 to 2009. Optimal donors were assigned to more severe cirrhotic patients (MELD ≥20); suboptimal organs were allocated to patients with hepatocellular carcinoma (HCC) not responsive to bridging therapies (specific priority score) or other exceptions with MELD 70 years, severe steatosis by ultrasound, and/or body mass index >30 kg/m2 , partial liver, or hepatitis C (HCV) or B virus positivity. Results Characteristics of the study group were a median age of 55 years (range, 27–68 years), HCV positivity in 164 patients (54%), HCC in 134 patients (44%), partial liver use in 25 (8%), MELD 15 (range, 6–40), D-age of 56 years (range, 18–87 years), and median D-MELD score 826 (range, 126–2,988). Overall graft survival was 84%, 79%, and 77% at 1, 3, and 5 years after LT, respectively. Logistic regression did not show a significant correlation between graft failure and D-MELD score in the absence of a significant D-MELD cutoff. Cox regression with D-MELD as the continuous variable showed a hazard ratio (HR) of 0.99 (95% confidence interval [CI], 0.99–1.00; P = NS); and with D-MELD as a dichotomic variable (≥0 to