Donor-recipient match is a matter of debate in liver transplantation. D-MELD (donor age × 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 <50% (5yrsPS<50%) was investigated. A prognosis calculator was implemented (http://www.D-MELD.com). Differences among D-MELD deciles allowed their regrouping into three D-MELD classes (A < 338, B 338-1628, C >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 5yrsPS<50% cutoff was identified only in HCV patients (D-MELD ≥ 1750). The innovative approach offered by D-MELD and covariates is helpful in predicting outcome after liver transplantation, especially in HCV recipients.
Balancing donor and recipient risk factors in liver transplantation: the value of D-MELD with particular reference to HCV recipients / Avolio A.W.; Cillo U.; Salizzoni M.; De Carlis L.; Colledan M.; Gerunda G.E.; Mazzaferro V.; Tisone G.; Romagnoli R.; Caccamo L.; Rossi M.; Vitale A.; Cucchetti A.; Lupo L.; Gruttadauria S.; Nicolotti N.; Burra P.; Gasbarrini A.; Agnes S.; Lirosi M.C.; Miele L.; Pompili M.; Siciliano M.; Perilli V.; Gaspari R.; Castagneto M.; Tandoi F.; Mangoni I.; Belli L.; Pinna A.D.; Cescon M.; Gridelli B.; Li Petri S.; Volpes R.; Pinelli D.; Fagiuoli S.; Montalti R.; Regalia E.; Rossi G.; Antonelli B.; Berloco P.; Lai Q.; Risaliti A.; Nicolini D.; Valente U.; Gelli M.; Morelli N.; Zamboni F.; Tondolo V.; Brotzu G.; Ettorre G.M.; Vennarecci G.; Bresadola F.; Baccarani U.; Toniutto P.L.; Manzia T.; Anselmo A.; Angelico M.; Calise F.; Scuderi V.; Romano M.; Rendina M.; Barone M.; Cuomo O.; Perrella A.; Santaniello W.; Donataccio M.; Dalle Ore G.; de Ville de J.; Monti L.. - In: AMERICAN JOURNAL OF TRANSPLANTATION. - ISSN 1600-6135. - STAMPA. - 11:12(2011), pp. 2724-2736. [10.1111/j.1600-6143.2011.03732.x]
Balancing donor and recipient risk factors in liver transplantation: the value of D-MELD with particular reference to HCV recipients.
CUCCHETTI, ALESSANDRO;PINNA, ANTONIO DANIELE;CESCON, MATTEO;
2011
Abstract
Donor-recipient match is a matter of debate in liver transplantation. D-MELD (donor age × 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 <50% (5yrsPS<50%) was investigated. A prognosis calculator was implemented (http://www.D-MELD.com). Differences among D-MELD deciles allowed their regrouping into three D-MELD classes (A < 338, B 338-1628, C >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 5yrsPS<50% cutoff was identified only in HCV patients (D-MELD ≥ 1750). The innovative approach offered by D-MELD and covariates is helpful in predicting outcome after liver transplantation, especially in HCV recipients.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
