Liver Allocation in Urgent MELD Score ≥30: The Italian Experience.
BACKGROUND
Patients with an urgent MELD score ≥30 are managed by the Italian Operative National Transplant Center on the basis of a division of Italy into 2 main areas, the northern macro area (NMA) and the southern macro area (SMA). The object of this study was to evaluate the possibility and the need to transform the MELD score ≥30 macro area-based program into a nationwide one.


METHODS
When a region reports the presence of a patient with a MELD score ≥30, the same macro area-compatible donors, in the absence of urgent national and 1B status, are offered primarily to this recipient.


RESULTS
From August 2014 to August 2015, 132 requests for patients with urgent MELD score ≥30, 98 from the NMA and 34 from the SMA, were handled. The average waiting list in the NMA was significantly different from that of the SMA (2.74 ± 2.29 vs 4.5 ± 3.98, P < .05). A total of 73.7% of the received requests (n = 97) were satisfied: the NMA met 80.4% of the requests (n = 77), whereas the SMA met 55.5% (n = 20). A total of 35 requests (26.5%), 21 from the NMA (60%) and 14 (40%) from the SMA, were not met. The average waiting time of these recipients for a liver was significantly different between the NMA and the SMA (3.14 ± 3.21 vs 5.78 ± 4.59; P < .05).


CONCLUSIONS
The MELD score is a priority allocation, and the longer the waiting time to transplantation for these recipients, the more their mortality increases. Given the differences in waiting times between the NMA and SMA, we should start thinking about transforming the macro area program into a national one.
Italian National Transplant Center, Rome, Italy. Electronic address: silvia.trapani@iss.it.
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Trapani
Italian National Transplant Center, Rome, Italy.
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Morabito
Italian National Transplant Center, Rome, Italy.
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Oliveti
Italian National Transplant Center, Rome, Italy.
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Peritore
Italian National Transplant Center, Rome, Italy.
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Rizzo
Italian National Transplant Center, Rome, Italy.
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Cacciotti
Italian National Transplant Center, Rome, Italy.
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Gaeta
Italian National Transplant Center, Rome, Italy.
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Montemurro
Italian National Transplant Center, Rome, Italy.
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Rizzato
Italian National Transplant Center, Rome, Italy.
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Nanni Costa
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007558:Italy; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D014019:Tissue Donors / Q000600:supply & distribution; D009927:Tissue and Organ Procurement / Q000379:methods*; D014850:Waiting Lists