The mismatch choice in liver transplantation: a suggestion for the selection of the recipient in relation to the characteristics of the donor.
Two hundred seventy-six liver transplants were retrospectively reviewed to analyze 6-month graft survival in relation to the combination of donor quality (standard donor vs nonstandard donor) and risk related to the severity of recipient liver disease low-risk, ie, United Network for Organ Sharing [UNOS] status 3/2b; high-risk, ie, UNOS status 1/2a). The overall 6-month survival rate of 82% was stratified into 4 classes: (1) standard donor to low-risk recipient = 88%; (2) standard donor to high-risk recipient = 86%; (3) nonstandard donor to low-risk recipient = 84%; and (4) nonstandard donor to high-risk recipient = 67%. According to the observed graft survival in the 4 different classes, 2 simulations were performed: the "match simulation" (transplantation of all low-risk recipients using standard donors, and transplantation of all high-risk recipients using nonstandard donors), and the "mismatch simulation" (transplantation of all the high-risk patients using low-risk donors and transplantation of low-risk patients using high-risk donors). The 6-month survival rates, calculated using the match simulation, were 74% and using the mismatch simulation, 84%. The authors suggest that, in the era of marginal donors, the recipient should be selected in relation to the characteristics of the donor according to the mismatch model.
Avolio
A W
AW
Transplant Unit, A. Gemelli Hospital, Catholic University of Rome, Rome, Italy. alfonso.avolio@tin.it
Nardo
B
B
Agnes
S
S
Montalti
R
R
Pepe
G
G
Cavallari
A
A
Castagneto
M
M
D003198:Computer Simulation; D006650:Histocompatibility Testing; D006801:Humans; D015993:Life Tables; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality; D018579:Patient Selection; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016896:Treatment Outcome