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Survival benefit after liver transplantation: a single European center experience.

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.

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  • Authors+Show Affiliations

    ,

    Liver and Multi-organ Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy. mrava1@hotmail.com

    , , , , , , , ,

    Source

    Transplantation 88:6 2009 Sep 27 pg 826-34

    MeSH

    Adolescent
    Adult
    Aged
    Carcinoma, Hepatocellular
    Europe
    Female
    Humans
    Kaplan-Meier Estimate
    Liver Failure
    Liver Neoplasms
    Liver Transplantation
    Male
    Middle Aged
    Proportional Hazards Models
    Prospective Studies
    Tissue and Organ Procurement
    Treatment Outcome
    Waiting Lists
    Young Adult

    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://Insights.ovid.com/pubmed?pmid=19920783 DB - PRIME DP - Unbound Medicine ER -