title: Survival benefit after liver transplantation: a single European center experience.
abstract: BACKGROUND
  The evaluation of the survival achieved with liver transplantation (LT) compared with remaining on the waiting list, the transplant benefit, should be the underlying principle of organ allocation.
  
  
  METHODS
  During 2004 to 2007 with an allocation system based on Model for End-Stage Liver Disease (MELD) score with exceptions, we prospectively evaluated the transplant benefit and its relation to the match between recipient and donor characteristics.
  
  
  RESULTS
  Among 575 patients listed for chronic liver disease, 218 (37.9%) underwent LT and 115 (20%) were removed from the list (76 deaths, 25 tumor progressions, and 14 sick conditions). The 1- and 3-year survival rates on the list were significantly related to MELD score more than or equal to 20 (57% and 33% vs. 88% and 66%, P<0.001) and to its progression during the waiting time, such as s-Na levels less than or equal to 135 mEq/L (73% and 48% vs. 86% and 69%, P<0.001). These two variables had no impact on survival after LT, except in hepatitis C virus positive recipients. The multivariate Cox model confirmed a positive transplant benefit for all cases with MELD score more than or equal to 20 and without hepatocellular carcinoma (HR 2.9; CI 1.3-6.2) independently of the type of donors. Only hepatocellular carcinoma patients with low MELD scores showed a positive transplant benefit (MELD <15; HR 2; CI 1.1-5.1).
  
  
  CONCLUSIONS
  LT should be reserved for cirrhotic patients with MELD score more than or equal to 20 independently of other recipient and donor matches or for cases with lower MELD score but with hepatocellular carcinoma.
authors.affiliation: Liver and Multi-organ Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy. mrava1@hotmail.com
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Grazi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Dazzi
authors.forename: Valentina
authors.initials: V
authors.lastname: Bertuzzo
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ercolani
authors.forename: Matteo
authors.initials: M
authors.lastname: Cescon
authors.forename: Alessandro
authors.initials: A
authors.lastname: Cucchetti
authors.forename: Michele
authors.initials: M
authors.lastname: Masetti
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ramacciato
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017093:Liver Failure / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014850:Waiting Lists; D055815:Young Adult