Balancing Donor and Recipient Risk Factors in Liver Transplantation: The Value of D-MELD With Particular Reference to HCV Recipients

被引：80

作者：

Avolio, A. W. ^{[1
,17
]}

Cillo, U. ^{[2
,24
]}

Salizzoni, M. ^{[3
,18
]}

De Carlis, L. ^{[4
,19
]}

Colledan, M. ^{[5
,22
]}

Gerunda, G. E. ^{[6
,23
]}

Mazzaferro, V. ^{[7
,25
]}

Tisone, G. ^{[8
,33
]}

Romagnoli, R. ^{[3
,18
]}

Caccamo, L. ^{[9
,26
]}

Rossi, M. ^{[10
,27
]}

Vitale, A. ^{[2
,24
]}

Cucchetti, A. ^{[11
,20
]}

Lupo, L. ^{[12
,35
]}

Gruttadauria, S. ^{[13
,21
]}

Nicolotti, N. ^{[14
,39
]}

Burra, P. ^{[15
,24
]}

Gasbarrini, A. ^{[16
,17
]}

Agnes, S. ^{[1
,17
]}

Lirosi, M. C. ^{[17
]}

Miele, L. ^{[17
]}

Pompili, M. ^{[17
]}

Siciliano, M. ^{[17
]}

Perilli, V. ^{[17
]}

Gaspari, R. ^{[17
]}

Castagneto, M. ^{[17
]}

Tandoi, F. ^{[18
]}

Mangoni, I. ^{[19
]}

Belli, L. ^{[19
]}

Pinna, A. D. ^{[20
]}

Cescon, M. ^{[20
]}

Gridelli, B. ^{[21
]}

Li Petri, S. ^{[21
]}

Volpes, R. ^{[21
]}

Pinelli, D. ^{[22
]}

Fagiuoli, S. ^{[22
]}

Montalti, R. ^{[23
]}

Regalia, E. ^{[25
]}

Rossi, G. ^{[26
]}

Antonelli, B. ^{[26
]}

Berloco, P. ^{[27
]}

Lai, Q. ^{[27
]}

Risaliti, A. ^{[28
]}

Nicolini, D. ^{[28
]}

Valente, U. ^{[29
]}

Gelli, M. ^{[29
]}

Morelli, N. ^{[29
]}

Zamboni, F. ^{[30
]}

Tondolo, V. ^{[30
]}

Ettorre, G. M. ^{[31
]}

机构：

[1] Catholic Univ, Gen Surg & Transplantat Unit, Dept Surg, A Gemelli Hosp, Rome, Italy

[2] Univ Padua, Hepatobiliary Surg & Liver Transplantat Unit, Dept Surg & Gastroenterol Sci, Padua, Italy

[3] Univ Turin, Gen Surg & Liver Transplantat Unit, S Giovanni Battista Hosp, Turin, Italy

[4] Osped Niguarda Ca Granda, Hepatobiliary Surg & Liver Transplantat Unit, Milan, Italy

[5] Osped Riuniti Bergamo, I-24100 Bergamo, Italy

[6] Univ Modena & Reggio Emilia, Liver & Multivisceral Transplantat Unit, Modena, Italy

[7] IRCCS Fdn, Liver Unit, Natl Canc Inst, Dept Surg, Milan, Italy

[8] Tor Vergata Univ Hosp, Gen Surg Ad Transplantat Unit, Dept Surg, Rome, Italy

[9] Maggiore Hosp, IRCCS Fdn, Gen Surg & Liver Transplantat Unit, Milan, Italy

[10] Univ Roma La Sapienza, Liver Transplantat Unit, Dept Gen Surg & Transplantat, Umberto I Hosp, Rome, Italy

[11] Univ Bologna, Liver & Multiorgan Transplantat Unit, Dept Gen Surg, S Orsola Hosp, Bologna, Italy

[12] Univ Bari, Gen Surg & Liver Transplantat Unit, Dept Emergency & Organ Transplantat, Bari, Italy

[13] IsMeTT UPMC, Palermo, Italy

[14] Catholic Univ, Epidemiol & Biostat Unit, Inst Hyg, Rome, Italy

[15] Univ Padua, Multivisceral Transplantat Unit, Dept Surg & Gastroenterol Sci, Padua, Italy

[16] Catholic Univ, Gastroenterol Unit, Dept Internal Med, Rome, Italy

[17] Catholic Univ, A Gemelli Hosp, Liver Transplantat Ctr, Rome, Italy

[18] Univ Turin, S Giovanni Battista Hosp, Liver Transplantat Ctr, Turin, Italy

[19] Osped Niguarda Ca Granda, Liver Transplantat Ctr, Milan, Italy

[20] Univ Bologna, S Orsola Hosp, Liver Transplantat Ctr, Bologna, Italy

[21] IsMeTT UPMC, Liver Transplantat Ctr, Palermo, Italy

[22] Osped Riuniti Bergamo, Liver Transplantat Ctr, Bergamo, Italy

[23] Univ Modena & Reggio Emilia, Liver Transplantat Ctr, Modena, Italy

[24] Univ Padua, Dept Surg & Gastroenterol Sci, Liver Transplantat Ctr, Padua, Italy

[25] IRCCS Fdn, Natl Canc Inst, Liver Transplantat Ctr, Milan, Italy

[26] Maggiore Hosp, IRCCS Fdn, Liver Transpantat Ctr, Milan, Italy

[27] Univ Roma La Sapienza, Umberto I Hosp, Liver Transplantat Ctr, Rome, Italy

[28] Polytech Univ Marche, Umberto I Hosp, Liver Transplantat Ctr, Ancona, Italy

[29] Univ Genoa, S Martino Hosp, Liver Transplantat Ctr, Genoa, Italy

[30] G Brotzu Univ Hosp, Liver Transplantat Ctr, Cagliari, Italy

[31] San Camillo Forlanini Hosp, Liver Transplantat Ctr, Rome, Italy

[32] Univ Udine, Liver Transplantat Ctr, Udine, Italy

[33] Tor Vergata Univ Hosp, Liver Transplantat Ctr, Rome, Italy

[34] A Cardarelli Univ Hosp, Hepatobiliary Surg Unit, Liver Transplantat Ctr, Naples, Italy

[35] Univ Bari, Dept Emergency & Organ Transplantat, Liver Transplantat Ctr, Bari, Italy

[36] A Cardarelli Univ Hosp, Laparoscop Hepatobiliary Surg Unit, Liver Transplantat Ctr, Naples, Italy

[37] Univ Verona, Maggiore Hosp, Liver Transplantat Ctr, Verona, Italy

[38] Bambino Gesu Pediat Hosp, Liver Transplantat Ctr, Rome, Italy

[39] Catholic Univ, Inst Hyg, Epidemiol & Biostat Unit, Rome, Italy

来源：

AMERICAN JOURNAL OF TRANSPLANTATION | 2011年 / 11卷 / 12期

关键词：

D-MELD; donor-recipient match; liver transplantation; outcome; prognosis; risk factors; HEPATITIS-C VIRUS; SURVIVAL BENEFIT; GRAFT-SURVIVAL; CENTER EXPERIENCE; PREDICT SURVIVAL; UNITED-STATES; MODEL; MORTALITY; ALLOCATION; DISEASE;

D O I：

10.1111/j.1600-6143.2011.03732.x

中图分类号：

R61 [外科手术学];

学科分类号：

100210 [外科学];

摘要：

Donorrecipient match is a matter of debate in liver transplantation. D-MELD (donor age x recipient biochemical model for end-stage liver disease [MELD]) and other factors were analyzed on a national Italian database recording 5946 liver transplants. Primary endpoint was to determine factors predictive of 3-year patient survival. D-MELD cutoff predictive of 5-year patient survival <50% (5yrsPS<50%) was investigated. A prognosis calculator was implemented (). Differences among D-MELD deciles allowed their regrouping into three D-MELD classes (A < 338, B 338-1628, C >1628). At 3 years, the odds ratio (OR) for death was 2.03 (95% confidence interval [CI], 1.442.85) in D-MELD class C versus B. The OR was 0.40 (95% CI, 0.24-0.66) in class A versus class B. Other predictors were hepatitis C virus (HCV; OR = 1.42; 95% CI, 1.11-1.81), hepatitis B virus (HBV; OR = 0.69; 95% CI, 0.51-0.93), retransplant (OR = 1.82; 95% CI, 1.16-2.87) and low-volume center (OR = 1.48; 95% CI, 1.1-11.99). Cox regressions up to 90 months confirmed results. The hazard ratio was 1.97 (95% CI, 1.592.43) for D-MELD class C versus class B and 0.42 (95% CI, 0.290.60) for D-MELD class A versus class B. Recipient age, HCV, HBV and retransplant were also significant. The 5yrsPS<50% cutoff was identified only in HCV patients (D-MELD = 1750). The innovative approach offered by D-MELD and covariates is helpful in predicting outcome after liver transplantation, especially in HCV recipients.

引用

页码：2724 / 2736

页数：13

共 45 条

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