D‐MELD, a Simple Predictor of Post Liver Transplant Mortality for Optimization of Donor/Recipient Matching

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...

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Bibliographic Details
Published in:American journal of transplantation 2009-02, Vol.9 (2), p.318-326
Main Authors: Halldorson, J. B., Bakthavatsalam, R., Fix, O., Reyes, J. D., Perkins, J. D.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age Factors
Aged
Aged, 80 and over
Biological and medical sciences
Child
Child, Preschool
Donor risk factors
Epidemiology
Gastroenterology. Liver. Pancreas. Abdomen
General aspects
Graft Survival
Histocompatibility Testing
Humans
Infant
Infant, Newborn
Liver Diseases - surgery
liver transplantation
Liver Transplantation - mortality
Liver, biliary tract, pancreas, portal circulation, spleen
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Medical sciences
Middle Aged
Models, Statistical
Other diseases. Semiology
Postoperative Complications
Predictive Value of Tests
Prognosis
Public health. Hygiene
Public health. Hygiene-occupational medicine
scoring
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Survival Rate
Tissue Donors
Young Adult
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Summary: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. This study of UNOS data developed a simple statistic, D‐MELD, for stratifying survival after liver transplantation and its potential application for allocation to improve donor/recipient matching.
ISSN:1600-6135
1600-6143
DOI:10.1111/j.1600-6143.2008.02491.x