title: Donor-Model for End-Stage Liver Disease and donor-recipient matching in liver transplantation.
abstract: BACKGROUND
  The product between donor (D) age and recipient (R) Model for End-Stage Liver Disease (MELD) score at the moment of liver transplantation (LT) has been proposed as a potential D-R matching tool to reduce the risk of "futile" LT from using the MELD score as the main allocation tool. The aim of this study was to evaluate the prognostic ability of D-MELD among a cohort of Italian patients already selected for LT on the basis of a D-R matching philosophy.
  
  
  METHODS
  We studied 303 consecutive adult patients undergoing first LT for chronic liver diseases with available D-MELD at the moment of LT from 2003 to 2009. Optimal donors were assigned to more severe cirrhotic patients (MELD ≥20); suboptimal organs were allocated to patients with hepatocellular carcinoma (HCC) not responsive to bridging therapies (specific priority score) or other exceptions with MELD <20. A suboptimal donor had age >70 years, severe steatosis by ultrasound, and/or body mass index >30 kg/m(2), partial liver, or hepatitis C (HCV) or B virus positivity.
  
  
  RESULTS
  Characteristics of the study group were a median age of 55 years (range, 27-68 years), HCV positivity in 164 patients (54%), HCC in 134 patients (44%), partial liver use in 25 (8%), MELD 15 (range, 6-40), D-age of 56 years (range, 18-87 years), and median D-MELD score 826 (range, 126-2,988). Overall graft survival was 84%, 79%, and 77% at 1, 3, and 5 years after LT, respectively. Logistic regression did not show a significant correlation between graft failure and D-MELD score in the absence of a significant D-MELD cutoff. Cox regression with D-MELD as the continuous variable showed a hazard ratio (HR) of 0.99 (95% confidence interval [CI], 0.99-1.00; P=NS); and with D-MELD as a dichotomic variable (≥0 to <1,600) an HR of 0.98 (95% CI, 0.63-1.77; P=NS).
  
  
  CONCLUSIONS
  The prognostic ability of D-MELD fails in OLT centers that use a more complex D-R matching policy.
authors.affiliation: Unità di Chirurgia Epatobiliare e Trapianto Epatico, Azienda-Università di Padova, Padova, Italy. alessandro.vitale@unipd.it
authors.forename: A
authors.initials: A
authors.lastname: Vitale
authors.forename: R
authors.initials: R
authors.lastname: Ramirez Morales
authors.forename: E
authors.initials: E
authors.lastname: dalla Bona
authors.forename: M
authors.initials: M
authors.lastname: Scopelliti
authors.forename: G
authors.initials: G
authors.lastname: Zanus
authors.forename: D
authors.initials: D
authors.lastname: Neri
authors.forename: F
authors.initials: F
authors.lastname: d'Amico
authors.forename: E
authors.initials: E
authors.lastname: Gringeri
authors.forename: F
authors.initials: F
authors.lastname: Russo
authors.forename: P
authors.initials: P
authors.lastname: Burra
authors.forename: P
authors.initials: P
authors.lastname: Angeli
authors.forename: U
authors.initials: U
authors.lastname: Cillo
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002908:Chronic Disease; D003661:Decision Support Techniques; D046148:Donor Selection; D005234:Fatty Liver / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D006085:Graft Survival; D006305:Health Status Indicators; D006509:Hepatitis B / Q000150:complications / Q000175:diagnosis; D006526:Hepatitis C / Q000150:complications / Q000175:diagnosis; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008107:Liver Diseases / Q000175:diagnosis / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult