OUTCOMES OF LIVER TRANSPLANTATION I

A.W. Avolio¹, U. Cillo², M. Rossi³, M. Colledan⁴, G. Tisone⁵, G. Gerunda⁶, G. Rossi⁷, U. Valente⁸, L. Lupo⁹, G.M. Ettorre¹⁰, A. Risaliti¹¹, V. Bresadola¹², B. Gridelli¹³, M. Donataccio¹⁴, O. Cuomo¹⁵, F. Calise¹⁵, A.D. Pinna¹⁶, L. De carlis¹⁷, F. Zamboni¹⁸, V. Mazzaferro¹⁹, N. Nicolotti¹, E. Nure¹, A. Vitale², Q. Lai²⁰, D. Pinelli⁴, D. Sforza⁵, R. Montalti⁶, L. Caccamo⁷, M. Gelli⁸, M. Rendina²¹, G. Vennarecci²², D. Nicolini¹¹, U. Baccarani¹², S. Gruttadauria¹³, A. Perrella¹⁵, A. Cucchetti¹⁶, J. Mangoni¹⁷, V. Tondolo¹⁸, E. Regalia¹⁹, A. Gasbarrini¹, M. Angelico⁵, S. Agnes^1
1Dept Of Surgery - Transplantation Service, Catholic University, Rome/ITALY, ²University Of Padua, Liver Transplant Unit, Padua/ITALY, ³General Surgery- Transplantation, Umberto I, Rome/ITALY, ⁴Transplantation Service, Ospedali Riuniti di Bergamo, Bergamo/ITALY, ⁵General And Transplant Surgery, Tor Vergata University of Rome, Rome/ITALY, ⁶Transplant Surgery, Policlinico di Modena, Modena/ITALY, ⁷Liver And Lung Transplantation Center, Ospedale Maggiore Milano, Milan/ITALY, ⁸General Surgery & Transplantation C, S. Martino, Genua/ITALY, ⁹Transplantation Division, Policlinico Bari, Bari/ITALY, ¹⁰Transplantation, S. Camillo-Forlanini, Rome/ITALY, ¹¹, Univ Marche, Ancona/ITALY, ¹²Surgery & Transplantation, University, Udine/ITALY, ¹³Transplant Center, ISMETT, Palermo/ITALY, ¹⁴Transplant Service, Azienda Ospedaliera di Verona, Verona/ITALY, ¹⁵Transplantation Center, Cardarelli Hospital, Naples/ITALY, ¹⁶, S. Orsola-Malpighi Hospital, Bologna/ITALY, ¹⁷Surgery&transplant, Niguarda Hospital, Milan/ITALY, ¹⁸General Surgery, AO Brotzu, Cagliari/ITALY, ¹⁹-, IS Tumori, Milan/ITALY, ²⁰General Surgery And Organ Transplantation, La Sapienza, Rome/ITALY, ²¹, Policlinico Universitario di Bari, Bari/ITALY, ²², Polo Ospedaliero Interaziendale Trapianti (POIT) “San Camillo-Forlanini”-INMI “L. Spallanzani”, Rome/ITALY

Body: Introduction: D-MELD (donor age x biochemical MELD) as expression of the donor-recipient match (DRM), has been proposed to predict the 4-yrs graft survival (GS) after liver transplantation (LT). As yet, the D-MELD has been investigated in the north American population only. Here we report the Italian retrospective multicenter analysis to evaluate the predictive power of D-MELD, at 1-8 years. Methods. 2878 consecutive first-transplants, performed in Italy from Jan 2002 to Dec 2008 in 20 centers, were analyzed. Cases were stratified in 10 classes using the decile method. Kaplan Meier, Cox regression and Hazard Ratio analyses (HR) were performed. Results. D-MELD significantly stratified the GS better than donor age or than MELD. The 80th percentile cut-off was identified at D-MELD equal to 1390 (Log rank X²=31,9; p<0.0001). In other words, the oldest liver that a patient with biochemical MELD equal to 30 can receive safely is from a donor <46 (1390/30=45,3); if MELD is 36 -> the safe donor age should be less than 39 (1390/36=38.6). According to the different decile classes (figure, 10 decile classes), HR increases from 1 (best match with the highest GS, reference line) to 4 (worse match with lowest GS). Relevant differences in the match stratification are among the 6 main indications to LT (figure). Using the Cox regression method a predictive model was obtained (GS from D-MELD, p<0.0001, X²=54,8). The introduction in the Cox model of HCV status and HBV status as covariates led to the increase of the prediction (p<0.0001, overall X²=78,5). Discussion. D-MELD is an easy and powerful formula able to guide the donor-recipient allocation. However the D-MELD prediction can be increased adopting a more complex Cox model which includes the indication to LT. Organs from aged donors should not be allocated to high-risk pts, particularly with viral disease. On the contrary, HCC patients who basically present low biochemical MELD values, should receive organs from aged donors. In order to obtain good GS dealing with elder donors and without excluding recipients with high MELD values, we suggest using D-MELD to guide the donor-recipient match in the everyday practice.

Disclosure: All authors have declared no conflicts of interest.