medigraphic.com
Órgano Oficial de la Asociación Mexicana de Hepatología

2014, Number 6

<< Back Next >>

Ann Hepatol 2014; 13 (6)

D-MELD does not predict post-liver transplantation survival: a single-center experience from Brazil

Costabeber AM, Lionço LC, Marroni C, Zanotelli ML, Cantisani G, Brandão A

Language: English
References: 34
Page: 781-787
PDF size: 105.30 Kb.


ABSTRACT

Background. The D-MELD score was designed to prevent donor-recipient matches with a high risk of unfavorable outcome. The main objective of the present study was to assess the predictive value of the DMELD score for 1-month and 3-month post-transplant mortality in a cohort of patients who underwent deceased-donor liver transplantation in Southern Brazil. Material and methods. A cohort study was conducted. Receiver operating characteristic c-statistics were used to determine the ability of the D-MELD score to predict mortality. The Kaplan-Meier method was used to analyze survival as a function of time regarding D-MELD scores, and the Cox model was employed to assess the association between D-MELD and mortality. Results. Most recipients were male, with a mean age of 54.3 ± 9.6 years (n = 233 transplants). Mean donor age was 44.9 ± 16.8 years (19.3% of donors were aged ≥ 60 years). Mean MELD and D-MELD scores were 16.3 ± 7.1 and 733.1 ± 437.8 respectively. Overall survival at 1 and 3 months was 83.6%. The c-statistic value for 1- and 3-month mortality was ‹ 0.5 for the D-MELD. Analysis of Kaplan-Meier curves for groups with D-MELD scores ‹ 1,600 and ≥ 1,600 did not show statistically significant differences in survival (p = 0.722). Conclusion. D-MELD scores were unable to predict survival in this cohort of Brazilian liver transplant recipients.


REFERENCES

  1. Burra P, De Martin E, Senzolo M. Evaluation of graft and recipient risk factors in liver transplantation. Digestive and Liver Disease Supplements 2009: 3; 108-11.

  2. Harring TR, O’Mahony CA, Goss JA. Extended donors in liver transplantation. Clin Liver Dis 2011; 15: 879-900. Doi: 10.1016/j.cld.2011.08.006. Costabeber AM, et al. , 2014; 13 (6): 781-787 786

  3. Cameron AM, Ghobrial RM, Yersiz H, Farmer DG, Lipshutz GS, Gordon SA, Zimmerman M, et al. Optimal utilization of donor grafts with extended criteria: a single-center experience in over 1000 liver transplants. Ann Surg 2006; 243: 748-53; discussion 53-5. Doi: 10.1097/ 01.sla.0000219669.84192.b3.

  4. Vitale A, D’Amico F, Brolese A, Zanus G, Boccagni P, Neri D, Gringeri E, et al. Prognostic impact of model for endstage liver disease score in patients undergoing liver transplantation with suboptimal livers. Transplant Proc 2007; 39: 1907-9. Doi: 10.1016/ j.transproceed.2007.05.032.

  5. Gordon Burroughs S, Busuttil RW. Optimal utilization of extended hepatic grafts. Surg Today 2009; 39: 746-51. Doi: 10.1007/s00595-008-4022-1.

  6. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, D’Amico G, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2001; 33: 464-70. Doi: 10.1053/jhep.2001.22172.

  7. Avolio AW, Nardo B, Agnes S, Montalti R, Pepe G, Cavallari A, Castagneto M, et al. The mismatch choice in liver transplantation: a suggestion for the selection of the recipient in relation to the characteristics of the donor. Transplant Proc 2005; 37: 2584-6. Doi: 10.1016/ j.transproceed.2005.06.054.

  8. Avolio AW, Agnes S, Gasbarrini A, Barbarino R, Nure E, Siciliano M, Barone M, et al. Allocation of nonstandard livers to transplant candidates with high MELD scores: Should this practice be continued? Transplant Proc 2006; 38: 3567-71. Doi: 10.1016/j.transproceed.2006.10.034.

  9. Bonney GK, Aldersley MA, Asthana S, Toogood GJ, Pollard SG, Lodge JPA, Prasad KR. Donor Risk Index and MELD Interactions in Predicting Long-Term Graft Survival: A Single- Centre Experience. Transplantation 2009; 87: 1858-63 10.097/TP.0b013e3181a75b37.

  10. Croome KP, Marotta P, Wall WJ, Dale C, Levstik MA, Chandok N, Hernandez-Alejandro R. Should a lower quality organ go to the least sick patient? Model for end-stage liver disease score and donor risk index as predictors of early allograft dysfunction. Transplant Proc 2012; 44: 1303-6. Doi: 10.1016/j.transproceed.2012.01.115.

  11. Avolio AW, Halldorson JB, Burra P, Dutkowski P, Agnes S, Clavien PA. Balancing Utility and Need by Means of Donorto- Recipient Matching: A Challenging Problem. Am J Transp 2013; 13: 522-3. Doi: 10.1111/ajt.12031.

  12. Feng S, Goodrich NP, Bragg-Gresham JL, Dykstra DM, Punch JD, DebRoy MA, Greenstein SM, et al. Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant 2006; 6: 783-90. Doi: 10.1111/j.1600-6143.2006.01242.x.

  13. Hoofnagle JH, Lombardero M, Zetterman RK, Lake J, Porayko M, Everhart J, Belle SH, et al. Donor age and outcome of liver transplantation. Hepatology 1996:24:89-96. Doi: 10.1002/hep.510240116.

  14. Greig PD, Forster J, Superina RA, Strasberg SM, Mohamed M, Blendis LM, Taylor BR, et al. Donor-specific factors predict graft function following liver transplantation. Transplant Proc 1990; 22: 2072-3.

  15. Deschênes M, Forbes C, Tchervenkov J, Barkun J, Metrakos P, Tector J, Alpert E. Use of older donor livers is associated with more extensive ischemic damage on intraoperative biopsies during liver transplantation. Liver Transplantation and Surgery 1999; 5: 357-61. Doi: 10.1002/lt.500050501.

  16. Busuttil RW, Farmer DG, Yersiz H, Hiatt JR, McDiarmid SV, Goldstein LI, Saab S, et al. Analysis of long-term outcomes of 3200 liver transplantations over two decades: a singlecenter experience. Ann Surg 2005; 241: 905-16; discussion 16-8.

  17. Burroughs AK, Sabin CA, Rolles K, Delvart V, Karam V, Buckels J, O’Grady JG, et al. 3-month and 12-month mortality after first liver transplant in adults in Europe: predictive models for outcome. Lancet 2006; 367: 225-32. Doi: 10.1016/S0140-6736(06)68033-1.

  18. Singhal A, Sezginsoy B, Ghuloom AE, Hutchinson IV, Cho YW, Jabbour N. Orthotopic liver transplant using allografts from geriatric population in the United States: is there any age limit? Exp Clin Transplant 2010; 8: 196-201.

  19. Álamo JM, Barrera L, Marín LM, Bernal C, Suárez G, Serrano J, Gómez MA, et al. Results of Liver Transplantation With Donors Older Than 70 Years: A Case-Control Study. Transplantation proceedings 2011; 43: 2227-9.

  20. Braat AE, Blok JJ, Putter H, Adam R, Burroughs AK, Rahmel AO, Porte RJ, et al. The Eurotransplant donor risk index in liver transplantation: ET-DRI. Am J Transplant 2012; 12: 2789-96. Doi: 10.1111/j.1600-6143.2012.04195.x.

  21. Grazi GL, Ravaioli M, Zanello M, Ercolani G, Cescon M, Varotti G, Del Gaudio M, et al. Using elderly donors in liver transplantation. Transplant Proc 2005; 37: 2582-3. Doi: 10.1016/j.transproceed.2005.06.056.

  22. Yersiz H, Shaked A, Olthoff K, Imagawa D, Shackleton C, Martin P, Busuttil RW. Correlation between donor age and the pattern of liver graft recovery after transplantation. Transplantation 1995; 60: 790-4.

  23. Halldorson JB, Bakthavatsalam R, Fix O, Reyes JD, Perkins JD. D-MELD, a simple predictor of post liver transplant mortality for optimization of donor/recipient matching. Am J Transplant 2009; 9: 318-26. Doi: 10.1111/j.1600- 6143.2008.02491.x.

  24. Wiesner RH, McDiarmid SV, Kamath PS, Edwards EB, Malinchoc M, Kremers WK, Krom RA, et al. MELD and PELD: application of survival models to liver allocation. Liver Transpl 2001; 7: 567-80. Doi: 10.1053/ jlts.2001.25879.

  25. Avolio AW, Cillo U, Salizzoni M, De Carlis L, Colledan M, Gerunda GE, Mazzaferro V, et al. Balancing donor and recipient risk factors in liver transplantation: the value of D-MELD with particular reference to HCV recipients. Am J Transplant 2011; 11: 2724-36. Doi: 10.1111/j.1600- 6143.2011.03732.x.

  26. Vitale A, Ramirez Morales R, dalla Bona E, Scopelliti M, Zanus G, Neri D, D’Amico F, et al. Donor-Model for End- Stage Liver Disease and donor-recipient matching in liver transplantation. Transplant Proc 2011; 43: 974-6. Doi: 10.1016/j.transproceed.2011.01.138.

  27. Schrem H, Reichert B, Fruhauf N, Becker T, Lehner F, Kleine M, Bektas H, et al. The Donor-Risk-Index, ECD-Score and D-MELD-Score all fail to predict short-term outcome after liver transplantation with acceptable sensitivity and specificity. Ann Transplant 2012; 17: 5-13.

  28. Asrani SK, Kim WR. Model for End-Stage Liver Disease: End of the First Decade. Clinics in Liver Disease 2011; 15: 685-98. Doi: http://dx.doi.org/10.1016/ j.cld.2011.08.009.

  29. Kamath PS, Wiesner R, Malinchoc M, Kremers W, Therneau T, Kosber C, D’Amico G, et al. A model to predict survival in patients with end-stage liver disease. Hepatology 2011; 33: 464-70.

  30. Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P, et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003; 124: 91-6. Doi: 10.1053/gast.2003.50016. 787 D-MELD and prediction of outcome. , 2014; 13 (6): 781-787

  31. Brandao A, Fuchs SC, Gleisner AL, Marroni C, Zanotelli ML, Cantisani G. MELD and other predictors of survival after liver transplantation. Clin Transplant 2009; 23: 220-7. Doi: 10.1111/j.1399-0012.2008.00943.x.

  32. Klein KB, Stafinski TD, Menon D. Predicting survival after liver transplantation based on pre-transplant MELD score: a systematic review of the literature. PLoS One 2013:8:e80661. doi: 10.1371/journal.pone.0080661.

  33. Rana A, Hardy MA, Halazun KJ, Woodland DC, Ratner LE, Samstein B, Guarrera JV, et al. Survival outcomes following liver transplantation (SOFT) score: a novel method to predict patient survival following liver transplantation. Am J Transplant 2008; 8: 2537-46. Doi: 10.1111/j.1600- 6143.2008.02400.x.

  34. Dutkowski P, Oberkofler CE, Slankamenac K, Puhan MA, Schadde E, Mullhaupt B, Geier A, et al. Are there better guidelines for allocation in liver transplantation? A novel score targeting justice and utility in the model for endstage liver disease era. Ann Surg 2011; 254: 745-53; discussion 53. Doi: 10.1097/SLA.0b013e3182365081.




2020     |     www.medigraphic.com