Original Articles
Balancing Donor and Recipient Risk Factors in Liver Transplantation: The Value of D-MELD With Particular Reference to HCV Recipients

https://doi.org/10.1111/j.1600-6143.2011.03732.xGet rights and content
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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 (http://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 approach offered by D-MELD and covariates is helpful in predicting outcome after liver transplantation, especially in HCV recipients.

Key words:

D-MELD
donor–recipient match
liver transplantation
outcome
prognosis
risk factors

Abbreviations:

AID
autoimmune disease
ALF
acute liver failure
CI
confidence interval
DCD
donation after cardiac death
D-MELD
arithmetical product of donor age and biochemical MELD
DRI
donor risk index
ELTR
European Liver Transplant Registry
HbcAb
hepatitis B anticore
HBV
hepatitis B virus
HCC
hepato-cellular carcinoma
HCV
hepatitis C virus
HR
hazard ratio
LTA
Lazio Transplant Agency
MELD
Model for End-stage Liver Disease
Mo
month
N
number
OR
odds ratio
UNOS-STAR
United Network for Organ Sharing-Standard Transplant Analysis and Research File
Yr
year
Yrs
years.

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