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.

Avolio, A. W., Salizzoni, M., De Carlis, L., Colledan, M., Gerunda, G., Mazzaferro, V., Tisone, G., Romagnoli, R., Caccamo, L., Rossi, M., Vitale, A., Cucchetti, A., Lupo, L., Gruttadauria, S., Nicolotti, N., Burra, P., Gasbarrini, A., Agnes, S., Balancing donor and recipient risk factors in liver transplantation: the value of D-MELD with particular reference to HCV recipients, <<AMERICAN JOURNAL OF TRANSPLANTATION>>, 2012; 2011 (Dicembre): 2724-2736 [http://hdl.handle.net/10807/37117]

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

Avolio, Alfonso Wolfango;Nicolotti, Nicola;Gasbarrini, Antonio;Agnes, Salvatore
2011

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.
Inglese
Avolio, A. W., Salizzoni, M., De Carlis, L., Colledan, M., Gerunda, G., Mazzaferro, V., Tisone, G., Romagnoli, R., Caccamo, L., Rossi, M., Vitale, A., Cucchetti, A., Lupo, L., Gruttadauria, S., Nicolotti, N., Burra, P., Gasbarrini, A., Agnes, S., Balancing donor and recipient risk factors in liver transplantation: the value of D-MELD with particular reference to HCV recipients, <<AMERICAN JOURNAL OF TRANSPLANTATION>>, 2012; 2011 (Dicembre): 2724-2736 [http://hdl.handle.net/10807/37117]
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