title: D-MELD as a predictor of early graft mortality in adult-to-adult living-donor liver transplantation.
abstract: BACKGROUND
  Ensuring a good match between donor and recipient is critically important to achieve acceptable graft outcomes after living-donor liver transplantation (LDLT). Our objective was to evaluate the product of donor age and Model for End-stage Liver Disease score (D-MELD) as a predictor of graft survival after LDLT.
  
  
  METHODS
  We retrospectively evaluated the records of 355 adults who underwent LDLT for chronic liver disease and explored the relationship between D-MELD and graft outcome.
  
  
  RESULTS
  High MELD score and advanced donor age were significantly associated with graft survival; D-MELD had the strongest association with in-hospital mortality. Receiver operating characteristic curve analysis showed that a D-MELD score of 462 had the highest sensitivity for predicting in-hospital mortality. Patients were allocated to three groups based on D-MELD (Class A [≤449; n=142], Class B [450-899; n=163], and Class C [≥900; n=50]) and were found to have stratified cumulative 2-year graft survivals of 94.1%, 85.3%, and 63.1%, respectively (P<0.01). Although D-MELD Class C patients had larger graft volume-to-standard liver volume ratio (P<0.01) and received right lobe grafts more often (P<0.01), they still exhibited significantly higher rates of primary graft dysfunction (P<0.01) and in-hospital mortality (P<0.01). Outcomes in D-MELD Class C were significantly worse in hepatitis C-positive patients (P<0.05).
  
  
  CONCLUSIONS
  The D-MELD score is a simple and reliable predictor of early graft survival that assists the matching of donors and recipients in LDLT in adults.
authors: 1 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 2 Address correspondence to: Toru Ikegami, M.D., Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
authors: Toru
authors: T
authors: Ikegami
authors: Daisuke
authors: D
authors: Imai
authors: Huanlin
authors: H
authors: Wang
authors: Tomoharu
authors: T
authors: Yoshizumi
authors: Yo-Ichi
authors: Y
authors: Yamashita
authors: Mizuki
authors: M
authors: Ninomiya
authors: Tomohiro
authors: T
authors: Iguchi
authors: Yuki
authors: Y
authors: Bekki
authors: Ken
authors: K
authors: Shirabe
authors: Yoshihiko
authors: Y
authors: Maehara
mesh_terms: D000328:Adult; D000367:Age Factors; D058625:End Stage Liver Disease / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006085:Graft Survival; D006526:Hepatitis C / Q000150:complications / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011336:Probability; D016016:Proportional Hazards Models; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index