Balancing Donor and Recipient Risk Factors in Liver Transplantation: The Value of D–MELD With Particular Reference to HCV Recipients


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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 (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.

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