Numerous donor and recipient risk factors interact to influence the probability of survival after liver transplantation.
Dr Halldorson and colleagues from Washington, USA developed a statistic, D-MELD, the product of donor age and preoperative MELD, calculated from laboratory values.
The team used the UNOS STAR national transplant data base, and obtained survival data for first liver transplant recipients with chronic liver failure from deceased after brain death donors.
Preoperative D-MELD score effectively stratified posttransplant survival.
The researchers used a cutoff D-MELD score of 1600.
|Regions with larger numbers of high D-MELD matches do not have higher survival rates|
|American Journal of Transplantation|
A subgroup of donor–recipient matches with significantly poorer short- and long-term outcomes was measured by survival and length of stay.
The team noted that avoidance of D-MELD scores above 1600 improved results for subgroups of high-risk patients with donor age 60, and those with preoperative MELD score of 30.
D-MELD scores of 1600 accurately predicted worse outcome in recipients with and without Hepatitis C.
The team found significant regional variation in average D-MELD scores at transplant.
However, regions with larger numbers of high D-MELD matches do not have higher survival rates.
Dr Halldorson’s team concluded, “D-MELD is a simple, highly predictive tool for estimating outcomes after liver transplantation.”
“This statistic could assist surgeons and their patients in making organ acceptance decisions.”
“Applying D-MELD to liver allocation could eliminate many donor/recipient matches likely to have inferior outcome.”