Donor-recipient MELD-based match in a patient who required three liver grafts in the era of nonstandard donors: case report.
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.
Avolio
A W
AW
Department of Surgery, Transplantation Service, Catholic University, A. Gemelli Hospital, Rome, Italy. alfonso.alvolio@rm.unicatt.it
Barbarino
R
R
Siciliano
M
M
Annicchiarico
B E
BE
Frongillo
F
F
Agnes
S
S
Castagneto
M
M
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