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D-MELD, a simple predictor of post liver transplant mortality for optimization of donor/recipient matching.

Abstract

Numerous donor and recipient risk factors interact to influence the probability of survival after liver transplantation. We developed a statistic, D-MELD, the product of donor age and preoperative MELD, calculated from laboratory values. Using the UNOS STAR national transplant data base, we analyzed survival for first liver transplant recipients with chronic liver failure from deceased after brain death donors. Preoperative D-MELD score effectively stratified posttransplant survival. Using a cutoff D-MELD score of 1600, we defined a subgroup of donor-recipient matches with significantly poorer short- and long-term outcomes as measured by survival and length of stay (LOS). Avoidance of D-MELD scores above 1600 improved results for subgroups of high-risk patients with donor age >/=60 and those with preoperative MELD >/=30. D-MELD >/=1600 accurately predicted worse outcome in recipients with and without hepatitis C. There is 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. 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.

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  • Authors+Show Affiliations

    ,

    Division of Transplantation, Department of Surgery, University of Washington, Seattle, WA, USA. jhalldor@u.washington.edu

    , , ,

    Source

    MeSH

    Adolescent
    Adult
    Age Factors
    Aged
    Aged, 80 and over
    Child
    Child, Preschool
    Graft Survival
    Histocompatibility Testing
    Humans
    Infant
    Infant, Newborn
    Liver Diseases
    Liver Transplantation
    Middle Aged
    Models, Statistical
    Postoperative Complications
    Predictive Value of Tests
    Prognosis
    Survival Rate
    Tissue Donors
    Young Adult

    Pub Type(s)

    Journal Article
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    19120079

    Citation

    Halldorson, J B., et al. "D-MELD, a Simple Predictor of Post Liver Transplant Mortality for Optimization of Donor/recipient Matching." American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, vol. 9, no. 2, 2009, pp. 318-26.
    Halldorson JB, Bakthavatsalam R, Fix O, et al. D-MELD, a simple predictor of post liver transplant mortality for optimization of donor/recipient matching. Am J Transplant. 2009;9(2):318-26.
    Halldorson, J. B., Bakthavatsalam, R., Fix, O., Reyes, J. D., & Perkins, J. D. (2009). D-MELD, a simple predictor of post liver transplant mortality for optimization of donor/recipient matching. American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 9(2), pp. 318-26. doi:10.1111/j.1600-6143.2008.02491.x.
    Halldorson JB, et al. D-MELD, a Simple Predictor of Post Liver Transplant Mortality for Optimization of Donor/recipient Matching. Am J Transplant. 2009;9(2):318-26. PubMed PMID: 19120079.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - D-MELD, a simple predictor of post liver transplant mortality for optimization of donor/recipient matching. AU - Halldorson,J B, AU - Bakthavatsalam,R, AU - Fix,O, AU - Reyes,J D, AU - Perkins,J D, Y1 - 2008/12/15/ PY - 2009/1/6/entrez PY - 2009/1/6/pubmed PY - 2009/3/27/medline SP - 318 EP - 26 JF - American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons JO - Am. J. Transplant. VL - 9 IS - 2 N2 - Numerous donor and recipient risk factors interact to influence the probability of survival after liver transplantation. We developed a statistic, D-MELD, the product of donor age and preoperative MELD, calculated from laboratory values. Using the UNOS STAR national transplant data base, we analyzed survival for first liver transplant recipients with chronic liver failure from deceased after brain death donors. Preoperative D-MELD score effectively stratified posttransplant survival. Using a cutoff D-MELD score of 1600, we defined a subgroup of donor-recipient matches with significantly poorer short- and long-term outcomes as measured by survival and length of stay (LOS). Avoidance of D-MELD scores above 1600 improved results for subgroups of high-risk patients with donor age >/=60 and those with preoperative MELD >/=30. D-MELD >/=1600 accurately predicted worse outcome in recipients with and without hepatitis C. There is 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. 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. SN - 1600-6143 UR - https://www.unboundmedicine.com/medline/citation/19120079/D_MELD_a_simple_predictor_of_post_liver_transplant_mortality_for_optimization_of_donor/recipient_matching_ L2 - https://doi.org/10.1111/j.1600-6143.2008.02491.x DB - PRIME DP - Unbound Medicine ER -