Prospective validation of a new priority allocation model for liver transplant candidates: an interim analysis.
BACKGROUND
The system that controls the waiting list (WL) and organ allocation for liver transplantation (OLT) seeks to achieve 3 main goals: objectivity, low dropout risks and good post-OLT results. We sought to prospectively validate a priority allocation model that is believed to achieve objectivity without penalizing dropout risk and post-OLT results.


METHODS
We evaluated a study group of 272 patients enrolled in 2006-2007. WL candidates were divided into 2 categories: cirrhotic patients classified according to Model for End-Stage Liver Disease (MELD) score (MELD list and patients with hepatocellular carcinoma (HCC) organized according to a specific score (non-MELD list). The allocation algorithm for donor-recipient match assigned an optimal graft to the first MELD candidate with a MELD score of >or=20; a suboptimal graft, to the first non-MELD patient. A respective control group of 327 patients transplanted from 2003-2006 was characterized by a unique WL with a free allocation policy. We performed an interim analysis of this prospectively controlled study.


RESULTS
Although the study group showed a lower percentage of OLT (P < .05) than the control group (37% vs 45%), it selected patients for OLT based on a higher MELD score (P < .05), thus obtaining similar dropout, post-OLT survivals, and intention-to-treat (ITT) survival probabilities as the controls. Among MELD patients, we observed a significantly reduced dropout and better ITT survival profiles than those of the control group (P = .02), whereas the similar results were delivered among non-MELD patients (P > .05). Among patients with a MELD score of >or=20, the prevalences of suboptimal grafts (0% vs 48%) and of early graft losses (0% vs 21%) were lower in the study than in the control group (P < .05).


CONCLUSIONS
We prospectively validated a priority allocation model based on objective criteria that achieved high ITT survival rates.
Vitale
A
A
Unità di Chirurgia Epatobiliare e Trapianto Epatico, Dipartimento di Chirurgia Generale e Trapianti d'Organo, Azienda Ospedaliera-Università di Padova, Padova, Italy.
Saracino
E
E
D'Amico
F E
FE
Grigoletto
F
F
Burra
P
P
Angeli
P
P
Boccagni
P
P
Brolese
A
A
Zanus
G
G
Neri
D
D
Gringeri
E
E
D'Amico
F
F
Valmasoni
M
M
Carraro
A
A
Gambato
M
M
Feltracco
P
P
Romano
A
A
Buggio
M
M
D'Amico
D F
DF
Cillo
U
U
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014850:Waiting Lists; D055815:Young Adult