Balancing donor and recipient risk factors in liver transplantation: The value of D-MELD with particular reference to HCV recipients

A. W. Avolio, U. Cillo, M. Salizzoni, L. De Carlis, M. Colledan, G. E. Gerunda, V. Mazzaferro, G. Tisone, R. Romagnoli, L. Caccamo, M. Rossi, A. Vitale, A. Cucchetti, L. Lupo, S. Gruttadauria, N. Nicolotti, P. Burra, A. Gasbarrini, S. Agnes, A. W. AvolioS. Agnes, M. C. Lirosi, A. Gasbarrini, L. Miele, M. Pompili, M. Siciliano, V. Perilli, R. Gaspari, M. Castagneto, M. Salizzoni, R. Romagnoli, F. Lupo, F. Tandoi, L. De Carlis, I. Mangoni, L. Belli, A. D. Pinna, A. Cucchetti, M. Cescon, B. Gridelli, S. Gruttadauria, S. Li Petri, R. Volpes, M. Colledan, D. Pinelli, S. Fagiuoli, V. Mazzaferro, E. Regalia, G. Dalle Ore, J. De Ville De Goyet, On behalf of the Donor-to-Recipient Italian Liver Transplant (D2R-ILTx) Study Group

Research output: Contribution to journalArticlepeer-review

Abstract

Donor-recipient match is a matter of debate in liver transplantation. D-MELD (donor age x 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 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 5 yrs PS

Original languageEnglish
Pages (from-to)2724-2736
Number of pages13
JournalAmerican Journal of Transplantation
Volume11
Issue number12
DOIs
Publication statusPublished - Dec 1 2011

Keywords

  • D-MELD
  • donor-recipient match
  • liver transplantation
  • outcome
  • prognosis
  • risk factors

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

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