title: Liver recipient survival rate before and after model for end-stage liver disease implementation and use of donor risk index.
abstract: BACKGROUND
  The progressive increase in the demand for liver transplantation has led to changes in donor selection and allocation, such as the Model for End-Stage Liver Disease Score (MELD). Characteristics related to the donor, recipient, and transplantation procedure influence the results. The use of expanded-criteria donors (ECDs) and the donor risk index (DRI) are strategies that have been proposed to increase the donors pool.
  
  
  OBJECTIVE
  We sought to study liver recipient survival before and after MELD implementation as well as the use of DRI.
  
  
  METHODS
  This retrospective study of prospectively collected data analyzed 1,786 liver recipients and their donors according to gender, age, cause of brain death, intensive care unit time, split liver, infection, ECD, cardiac arrest, cold ischemia time, waiting list time, and donor origin. MELD (without special scoring) and DRI were calculated from the recorded data. The periods of this study were 2004-2006 (pre-MELD) and 2006-2008 (post-MELD). For survival times, we performed the Kaplan-Meier method with log-rank tests and Cox regression analysis (prediction). The Kolmogorov-Sminorv test was used for sample comparisons.
  
  
  RESULTS
  The 1-year survivals were similar in the 2 periods (65.4% vs 67.6%). The predictive factors for death among the whole population were DRI >1.5, cold ischemia time ≥9 hours, MELD ≥25, female recipient, and longer waiting list time.
  
  
  CONCLUSIONS
  MELD is an important tool for allocation, resulting in a reduced waiting list, increased number of split-liver procedures, and use of ECDs without deterioration of survival times. DRI >1.7 was associated with shorter survival.
authors.affiliation: Faculty of Medical Sciences, Unicamp, Sao Paulo, Brazil.
authors.forename: H O Manduca
authors.initials: HO
authors.lastname: Palmiero
authors.forename: P
authors.initials: P
authors.lastname: Kajikawa
authors.forename: I F S F
authors.initials: IF
authors.lastname: Boin
authors.forename: S
authors.initials: S
authors.lastname: Coria
authors.forename: L A
authors.initials: LA
authors.lastname: Pereira
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors