title: Balancing donor and recipient risk factors in liver transplantation: the value of D-MELD with particular reference to HCV recipients.
abstract: Donor-recipient match is a matter of debate in liver transplantation. D-MELD (donor age × recipient biochemical model for end-stage liver disease [MELD]) and other factors were analyzed on a national Italian database recording 5946 liver transplants. Primary endpoint was to determine factors predictive of 3-year patient survival. D-MELD cutoff predictive of 5-year patient survival <50% (5yrsPS<50%) was investigated. A prognosis calculator was implemented (http://www.D-MELD.com). Differences among D-MELD deciles allowed their regrouping into three D-MELD classes (A < 338, B 338-1628, C >1628). At 3 years, the odds ratio (OR) for death was 2.03 (95% confidence interval [CI], 1.44-2.85) in D-MELD class C versus B. The OR was 0.40 (95% CI, 0.24-0.66) in class A versus class B. Other predictors were hepatitis C virus (HCV; OR = 1.42; 95% CI, 1.11-1.81), hepatitis B virus (HBV; OR = 0.69; 95% CI, 0.51-0.93), retransplant (OR = 1.82; 95% CI, 1.16-2.87) and low-volume center (OR = 1.48; 95% CI, 1.11-1.99). Cox regressions up to 90 months confirmed results. The hazard ratio was 1.97 (95% CI, 1.59-2.43) for D-MELD class C versus class B and 0.42 (95% CI, 0.29-0.60) for D-MELD class A versus class B. Recipient age, HCV, HBV and retransplant were also significant. The 5yrsPS<50% cutoff was identified only in HCV patients (D-MELD ≥ 1750). The innovative approach offered by D-MELD and covariates is helpful in predicting outcome after liver transplantation, especially in HCV recipients.
authors.affiliation: General Surgery and Transplantation Unit, Department of Surgery, A. Gemelli Hospital, Catholic University, Rome, Italy. alfonso.avolio@rm.unicatt.it
authors.forename: A W
authors.initials: AW
authors.lastname: Avolio
authors.forename: U
authors.initials: U
authors.lastname: Cillo
authors.forename: M
authors.initials: M
authors.lastname: Salizzoni
authors.forename: L
authors.initials: L
authors.lastname: De Carlis
authors.forename: M
authors.initials: M
authors.lastname: Colledan
authors.forename: G E
authors.initials: GE
authors.lastname: Gerunda
authors.forename: V
authors.initials: V
authors.lastname: Mazzaferro
authors.forename: G
authors.initials: G
authors.lastname: Tisone
authors.forename: R
authors.initials: R
authors.lastname: Romagnoli
authors.forename: L
authors.initials: L
authors.lastname: Caccamo
authors.forename: M
authors.initials: M
authors.lastname: Rossi
authors.forename: A
authors.initials: A
authors.lastname: Vitale
authors.forename: A
authors.initials: A
authors.lastname: Cucchetti
authors.forename: L
authors.initials: L
authors.lastname: Lupo
authors.forename: S
authors.initials: S
authors.lastname: Gruttadauria
authors.forename: N
authors.initials: N
authors.lastname: Nicolotti
authors.forename: P
authors.initials: P
authors.lastname: Burra
authors.forename: A
authors.initials: A
authors.lastname: Gasbarrini
authors.forename: S
authors.initials: S
authors.lastname: Agnes
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D046148:Donor Selection; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D006085:Graft Survival; D006305:Health Status Indicators; D016174:Hepacivirus / Q000472:pathogenicity; D006526:Hepatitis C / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors; D055815:Young Adult