title: Are there better guidelines for allocation in liver transplantation? A novel score targeting justice and utility in the model for end-stage liver disease era.
abstract: OBJECTIVE
  To design a new score on risk assessment for orthotopic liver transplantation (OLT) based on both donor and recipient parameters.
  
  
  BACKGROUND
  The balance of waiting list mortality and posttransplant outcome remains a difficult task in the era of the model for end-stage liver disease (MELD).
  
  
  METHODS
  Using the United Network for Organ Sharing database, a risk analysis was performed in adult recipients of OLT in the United States of America between 2002 and 2010 (n = 37,255). Living donor-, partial-, or combined-, and donation after cardiac death liver transplants were excluded. Next, a risk score was calculated (balance of risk score, BAR score) on the basis of logistic regression factors, and validated using our own OLT database (n = 233). Finally, the new score was compared with other prediction systems including donor risk index, survival outcome following liver transplantation, donor-age combined with MELD, and MELD score alone.
  
  
  RESULTS
  Six strongest predictors of posttransplant survival were identified: recipient MELD score, cold ischemia time, recipient age, donor age, previous OLT, and life support dependence prior to transplant. The new balance of risk score stratified recipients best in terms of patient survival in the United Network for Organ Sharing data, as in our European population.
  
  
  CONCLUSIONS
  The BAR system provides a new, simple and reliable tool to detect unfavorable combinations of donor and recipient factors, and is readily available before decision making of accepting or not an organ for a specific recipient. This score may offer great potential for better justice and utility, as it revealed to be superior to recent developed other prediction scores.
authors: Swiss HPB and Transplant Center, Department of Surgery and Transplantation, Switzerland.
authors: Philipp
authors: P
authors: Dutkowski
authors: Christian E
authors: CE
authors: Oberkofler
authors: Ksenija
authors: K
authors: Slankamenac
authors: Milo A
authors: MA
authors: Puhan
authors: Erik
authors: E
authors: Schadde
authors: Beat
authors: B
authors: Müllhaupt
authors: Andreas
authors: A
authors: Geier
authors: Pierre A
authors: PA
authors: Clavien
mesh_terms: D000328:Adult; D050377:Cold Ischemia; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D017408:Guidelines as Topic; D015276:Health Care Rationing / Q000592:standards*; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D040841:Resource Allocation / Q000592:standards*; D018570:Risk Assessment; D012720:Severity of Illness Index; D009927:Tissue and Organ Procurement / Q000592:standards*; D014481:United States; D014850:Waiting Lists