title: D-MELD risk capping improves post-transplant and overall mortality under markov microsimulation.
abstract: To hypothesize that the product of calculated Model for End-Stage Liver Disease score excluding exception points and donor age (D-MELD) risk capping ± Rule 14 could improve post liver transplant and overall survival after listing.
  
  
  
  Probabilities derived from the United Network for Organ Sharing database between 2002 and 2004 were used to simulate potential outcomes for all patients listed for transplantation. The Markov simulation was then modified by screening matches using a 1200 or 1600 D-MELD risk cap ± allowing transplants for Model for End-Stage Liver Disease (MELD) ≤ 14 (Rule 14). The differential impact of the rule changes was assessed.
  
  
  
  The Markov simulation accurately reproduced overall and post transplant survival. A 1200 D-MELD risk cap improved post-transplant survival. Both the 1200 and 1600 risk caps improved overall survival for waitlisted patients. The addition of Rule 14 further improved post transplant and overall survival by redistribution of donor livers to recipients in higher MELD subgroups. The mechanism for improved overall and post-transplant survival after listing was due to shifting a larger percentage of transplants to the moderate MELD score subgroup (MELD 15-29) while also ensuring that high MELD recipients have livers of high quality to achieve excellent post transplant survival.
  
  
  
  A 1200 D-MELD risk cap + Rule 14 provided the greatest overall benefit primarily by focusing liver transplantation towards the moderate MELD recipient.
authors.affiliation: Jeffrey B Halldorson, Division of Transplant Surgery, Department of Surgery, University of California, San Diego, CA 92103-8401, United States.
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Halldorson
authors.affiliation: Jeffrey B Halldorson, Division of Transplant Surgery, Department of Surgery, University of California, San Diego, CA 92103-8401, United States.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Carithers
authors.affiliation: Jeffrey B Halldorson, Division of Transplant Surgery, Department of Surgery, University of California, San Diego, CA 92103-8401, United States.
authors.forename: Renuka
authors.initials: R
authors.lastname: Bhattacharya
authors.affiliation: Jeffrey B Halldorson, Division of Transplant Surgery, Department of Surgery, University of California, San Diego, CA 92103-8401, United States.
authors.forename: Ramasamy
authors.initials: R
authors.lastname: Bakthavatsalam
authors.affiliation: Jeffrey B Halldorson, Division of Transplant Surgery, Department of Surgery, University of California, San Diego, CA 92103-8401, United States.
authors.forename: Iris W
authors.initials: IW
authors.lastname: Liou
authors.affiliation: Jeffrey B Halldorson, Division of Transplant Surgery, Department of Surgery, University of California, San Diego, CA 92103-8401, United States.
authors.forename: Andre A
authors.initials: AA
authors.lastname: Dick
authors.affiliation: Jeffrey B Halldorson, Division of Transplant Surgery, Department of Surgery, University of California, San Diego, CA 92103-8401, United States.
authors.forename: Jorge D
authors.initials: JD
authors.lastname: Reyes
authors.affiliation: Jeffrey B Halldorson, Division of Transplant Surgery, Department of Surgery, University of California, San Diego, CA 92103-8401, United States.
authors.forename: James D
authors.initials: JD
authors.lastname: Perkins
keywords: Donor age; Donor/recipient matching; Liver transplantation; Markov microsimulation; Model for End-Stage Liver Disease; The product of calculated Model for End-Stage Liver Disease score excluding exception points and donor age