title: Model for End-Stage Liver Disease (MELD) system to allocate and to share livers: experience of two Italian centers.
abstract: BACKGROUND
  The use of the Model for End-stage Liver Disease (MELD) score to prioritize patients on liver waiting lists and to share organs among centers was effective according to US data, but few reports are available in Europe.
  
  
  METHODS
  We evaluated the outcome of 887 patients listed between April 2004 and July 2006 in a common list by two transplant centers (University of Bologna [BO] and University of Modena [MO] ordered according to the MELD system. Patients with hepatocellular carcinoma had a score calculated according to their real MELD, tumor stage, and waiting time.
  
  
  RESULTS
  Five hundred eighty-six (67%) patients were listed from BO and 291 (33%) from MO. The clinical features of recipients (sex, age, blood group, and real MELD) were comparable between centers. The number of liver transplantations performed was 307, and 273 (89%) recipients had a calculated MELD >or=20. Liver transplantations were equally distributed according to the number of patients listed: 215 out of 586 (36.7%) for BO and 92 out of 291 (31.6%) for MO. The median real MELD of patients transplanted was 20, and 246 out of 307 (80.1%) grafts transplanted were functioning. The dropouts from the list were 124 (14%), and 87 (70%) of these patients had a calculated MELD >or=20.
  
  
  CONCLUSIONS
  The MELD system was effective to share livers among the two Italian centers. According to this policy, livers were allocated to the recipients with the highest probability of dropout and who had a satisfactory survival after liver transplantation.
authors.affiliation: Department of Liver and Multi-organ Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy. mrava1@hotmail.com
authors.forename: M
authors.initials: M
authors.lastname: Ravaioli
authors.forename: M
authors.initials: M
authors.lastname: Masetti
authors.forename: A
authors.initials: A
authors.lastname: Dazzi
authors.forename: A
authors.initials: A
authors.lastname: Romano
authors.forename: M
authors.initials: M
authors.lastname: Spaggiari
authors.forename: G L
authors.initials: GL
authors.lastname: Grazi
authors.forename: G
authors.initials: G
authors.lastname: Ercolani
authors.forename: M
authors.initials: M
authors.lastname: Cescon
authors.forename: P
authors.initials: P
authors.lastname: Di Gioia
authors.forename: N
authors.initials: N
authors.lastname: De Ruvo
authors.forename: R
authors.initials: R
authors.lastname: Montalti
authors.forename: R
authors.initials: R
authors.lastname: Ballarin
authors.forename: F
authors.initials: F
authors.lastname: Di Benedetto
authors.forename: L
authors.initials: L
authors.lastname: Ridolfi
authors.forename: N
authors.initials: N
authors.lastname: Alvaro
authors.forename: G
authors.initials: G
authors.lastname: Ramacciato
authors.forename: C
authors.initials: C
authors.lastname: Morelli
authors.forename: E
authors.initials: E
authors.lastname: Gerunda
authors.forename: A D
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D005260:Female; D006498:Hepatectomy; D006801:Humans; D007558:Italy; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D019520:Living Donors / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D040841:Resource Allocation / Q000379:methods; D014019:Tissue Donors / Q000706:statistics & numerical data; D020858:Tissue and Organ Harvesting / Q000379:methods*; D009927:Tissue and Organ Procurement / Q000379:methods*; D016896:Treatment Outcome; D014850:Waiting Lists