title: Donor-recipient MELD-based match in a patient who required three liver grafts in the era of nonstandard donors: case report.
abstract: In recent studies, nonstandard donors and high Model for End-stage Liver Disease (MELD) values have been indicated as risk factors for both graft survival and patient survival. A recent debate concerns which donor and recipient match guarantees the best results in terms of early and late survival. To emphasize the role of the donor-recipient match, we have reported herein a complex case of a patient who changed his preoperative risk status, being transplanted three times using donors of different risk levels. At each transplant, the patient moved to a higher MELD class: first transplant MELD=22; second transplant MELD=37; third transplant MELD=38. Only at the third transplant did the patient recover. Besides the liver, almost all his organs (kidneys, heart, lungs) recovered in a few weeks, as well. Unfortunately, severe cortical and subcortical brain damage remained a crucial limiting impairment, leading to death 5 months later, due to pulmonary infection, yet with a perfectly working liver. We underlined the role of donor factors to predict the outcome after liver transplantation in the MELD era.
authors.affiliation: Department of Surgery, Transplantation Service, Catholic University, A. Gemelli Hospital, Rome, Italy. alfonso.alvolio@rm.unicatt.it
authors.forename: A W
authors.initials: AW
authors.lastname: Avolio
authors.forename: R
authors.initials: R
authors.lastname: Barbarino
authors.forename: M
authors.initials: M
authors.lastname: Siciliano
authors.forename: B E
authors.initials: BE
authors.lastname: Annicchiarico
authors.forename: F
authors.initials: F
authors.lastname: Frongillo
authors.forename: S
authors.initials: S
authors.lastname: Agnes
authors.forename: M
authors.initials: M
authors.lastname: Castagneto
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D017809:Fatal Outcome; D005260:Female; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data*; D014019:Tissue Donors