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Survival benefit after liver transplantation: a single European center experience.
Transplantation 2009; 88(6):826-34T

Abstract

BACKGROUND

The evaluation of the survival achieved with liver transplantation (LT) compared with remaining on the waiting list, the transplant benefit, should be the underlying principle of organ allocation.

METHODS

During 2004 to 2007 with an allocation system based on Model for End-Stage Liver Disease (MELD) score with exceptions, we prospectively evaluated the transplant benefit and its relation to the match between recipient and donor characteristics.

RESULTS

Among 575 patients listed for chronic liver disease, 218 (37.9%) underwent LT and 115 (20%) were removed from the list (76 deaths, 25 tumor progressions, and 14 sick conditions). The 1- and 3-year survival rates on the list were significantly related to MELD score more than or equal to 20 (57% and 33% vs. 88% and 66%, P<0.001) and to its progression during the waiting time, such as s-Na levels less than or equal to 135 mEq/L (73% and 48% vs. 86% and 69%, P<0.001). These two variables had no impact on survival after LT, except in hepatitis C virus positive recipients. The multivariate Cox model confirmed a positive transplant benefit for all cases with MELD score more than or equal to 20 and without hepatocellular carcinoma (HR 2.9; CI 1.3-6.2) independently of the type of donors. Only hepatocellular carcinoma patients with low MELD scores showed a positive transplant benefit (MELD <15; HR 2; CI 1.1-5.1).

CONCLUSIONS

LT should be reserved for cirrhotic patients with MELD score more than or equal to 20 independently of other recipient and donor matches or for cases with lower MELD score but with hepatocellular carcinoma.

Authors+Show Affiliations

Liver and Multi-organ Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy. mrava1@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19920783

Citation

Ravaioli, Matteo, et al. "Survival Benefit After Liver Transplantation: a Single European Center Experience." Transplantation, vol. 88, no. 6, 2009, pp. 826-34.
Ravaioli M, Grazi GL, Dazzi A, et al. Survival benefit after liver transplantation: a single European center experience. Transplantation. 2009;88(6):826-34.
Ravaioli, M., Grazi, G. L., Dazzi, A., Bertuzzo, V., Ercolani, G., Cescon, M., ... Pinna, A. D. (2009). Survival benefit after liver transplantation: a single European center experience. Transplantation, 88(6), pp. 826-34. doi:10.1097/TP.0b013e3181b26807.
Ravaioli M, et al. Survival Benefit After Liver Transplantation: a Single European Center Experience. Transplantation. 2009 Sep 27;88(6):826-34. PubMed PMID: 19920783.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Survival benefit after liver transplantation: a single European center experience. AU - Ravaioli,Matteo, AU - Grazi,Gian Luca, AU - Dazzi,Alessandro, AU - Bertuzzo,Valentina, AU - Ercolani,Giorgio, AU - Cescon,Matteo, AU - Cucchetti,Alessandro, AU - Masetti,Michele, AU - Ramacciato,Giovanni, AU - Pinna,Antonio Daniele, PY - 2009/11/19/entrez PY - 2009/11/19/pubmed PY - 2009/12/16/medline SP - 826 EP - 34 JF - Transplantation JO - Transplantation VL - 88 IS - 6 N2 - BACKGROUND: The evaluation of the survival achieved with liver transplantation (LT) compared with remaining on the waiting list, the transplant benefit, should be the underlying principle of organ allocation. METHODS: During 2004 to 2007 with an allocation system based on Model for End-Stage Liver Disease (MELD) score with exceptions, we prospectively evaluated the transplant benefit and its relation to the match between recipient and donor characteristics. RESULTS: Among 575 patients listed for chronic liver disease, 218 (37.9%) underwent LT and 115 (20%) were removed from the list (76 deaths, 25 tumor progressions, and 14 sick conditions). The 1- and 3-year survival rates on the list were significantly related to MELD score more than or equal to 20 (57% and 33% vs. 88% and 66%, P<0.001) and to its progression during the waiting time, such as s-Na levels less than or equal to 135 mEq/L (73% and 48% vs. 86% and 69%, P<0.001). These two variables had no impact on survival after LT, except in hepatitis C virus positive recipients. The multivariate Cox model confirmed a positive transplant benefit for all cases with MELD score more than or equal to 20 and without hepatocellular carcinoma (HR 2.9; CI 1.3-6.2) independently of the type of donors. Only hepatocellular carcinoma patients with low MELD scores showed a positive transplant benefit (MELD <15; HR 2; CI 1.1-5.1). CONCLUSIONS: LT should be reserved for cirrhotic patients with MELD score more than or equal to 20 independently of other recipient and donor matches or for cases with lower MELD score but with hepatocellular carcinoma. SN - 1534-6080 UR - https://www.unboundmedicine.com/medline/citation/19920783/Survival_benefit_after_liver_transplantation:_a_single_European_center_experience_ L2 - http://dx.doi.org/10.1097/TP.0b013e3181b26807 DB - PRIME DP - Unbound Medicine ER -