Balancing donor and recipient risk factors in liver transplantation: the value of D-MELD with particular reference to HCV recipients.
Articolo
Data di Pubblicazione:
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.
Tipologia CRIS:
03A-Articolo su Rivista
Keywords:
Trapianto epatico; fattori di rischio; D-MELD; HCV
Elenco autori:
Avolio AW; Cillo U; Salizzoni M; De Carlis L; Colledan M; Gerunda GE; 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; Donor-to-Recipient Italian Liver Transplant Study Group
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