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Can we match donors and recipients in a cost-effective way?
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Can donors with high donor risk indices be used cost-effectively in liver transplantation in US Transplant Centers? [Transpl Int. 2013
Use of O blood group liver donors for nonidentical recipients: does this represent a double penalty for O blood group candidates?
No full textBackground. Blood group O candidates remain on the waiting list for a liver transplant for a longer time than candidates of other blood groups. Herein, we analyzed potential factors affecting waiting times in the period that preceded the introduction of the model for end-stage liver disease (MELD) and in MELD era, remarking possible corrections introduced by the adoption of the MELD.
Methods. Our analysis was entirely based on data obtained from the “Organ Procurement and Transplantation Net- work”, referring to the periods before and after the adoption of the MELD.
Results. In the MELD era, taking into consideration all candidates, the cumulative probability of remaining on the waiting list significantly diminished whereas that of undergoing transplantation significantly increased when compared with the pre-MELD era. However, group O candidates maintained the lowest cumulative probability of undergoing liver transplant, in all MELD classes, and the highest percentage of list removal for death/too sick. What caused the highest disadvantage for group O, in both eras, was the use of group O organs for ABO-compatible transplants, even in the absence of urgency. In candidates receiving ABO-compatible organs a significantly lower graft survival rate was observed compared with candidates receiving ABO-identical organs, even when the analysis was adjusted for the MELD score.
Conclusions. The introduction of the MELD significantly reduced the waiting time for all candidates as also the shift of group O organs. Limiting ABO-compatible organs exclusively to urgent cases would have a positive effect not only in terms of individual justice, but also terms of in general utility, considering the effect of ABO-matching on graft survival.
Keywords: MELD, Waiting list disparities, Liver transplant, ABO-matching, Graft survival
Allocation of nonstandard livers to transplant candidates with high MELD scores: Should this practice be continued?
No full textMELD and PELD scores of 255 consecutive grafts were calculated (236 adult cases and 19 pediatric cases). No correction for the etiology of liver disease was performed. Retransplants were excluded. Three categories of patients were identified: low MELD (scores = 25, n = 35). Grafts were categorized according to donor quality: standard livers (n = 199), vs nonstandard livers (n = 56). Nonstandard livers were identified by age >= 60, or at least by two of the following conditions: severe hemodynamic instability, ultrasound evidence of steatosis, natriemia >= 155 mEq/L, ICU stay > 7 days, liver trauma, protracted anoxia as cause of brain death, transaminases levels X 4. In standard livers, the 12-month graft survival (GS) for low, intermediate, and high MELD classes were 88%, 74%, and 77%, respectively. In nonstandard livers, the 12-month GS for the low, intermediate, and high MELD classes were 84%, 55%, and 44%, respectively; differences between low MELD class and both intermediate and high MELD classes were significant (P < .05). Cox regression analysis of all cases identified the following parameters as independent predictors of GS: donor status; donor age; and recipient creatinine. The highest correlation with GS was found using donor age and recipient creatinine as covariates. In standard livers no variable was able to predict GS. In nonstandard livers the MELD-PELD score was the unique variable able to predict GS. We suggest avoiding the use of nonstandard livers for patients with high MELD scores
L-GrAFT and EASE scores in liver transplantation. Need for a reciprocal external validation and comparison with other scores
No full textDonor Risk Index and MELD score interactions in graft survival prediction after liver transplantation. An analysis of the OPTN-UNOS database
No full textDonor Risk Index (DRI) has been introduced to predict post-transplant graft survival (GS) using donor data.
The MELD score, which is the gold-standard in scoring liver disease in liver transplant candidates, has a low prognostic
significance. The present analysis is aimed to assess the role of DRI and of MELD score in predicting the outcome after
liver transplantation, in short (180 days) and medium term (1460 days). The Organ Procurement Transplantation Network (OPTN) database relevant to 23.392 consecutive cases in the MELD era was used. Cases were stratified in classes according to DRI (4 classes), MELD (6 classes), and DRI-MELD match (24 classes). GS was assessed by Kaplan Meier method at 0-1460 days. Differences were tested by Log-rank test.
All three parameters allow an effective stratification. Using the DRI, the gaps between the highest and lowest GS were
7.8% and 14.9%, at 180 and 1460 days, respectively. Using the MELD score, the gaps were 10.2% and 9.5%,
respectively. Using DRI-MELD, the gaps were 25.5% and 35.4%, respectively. Both the DRI and the MELD can predict
the outcome, although the predictive power of the DRI is the highest of the two, and the predictive power of the donorrecipient match, is even higher.
The combination of DRI and MELD represents the best prognostic index in both short and medium-term observation
period. On the basis of our results we believe that, in order to increase GS without refusing donors with high DRI, we
should not allocate these organs to patients with a high MELD score
Conversione a TACROLIMUS MELTDOSE*TM nel Paziente Trapiantato di Fegato. Esperienza iniziale di Centro
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Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Molecular adsorbent recirculating system (Mars) in patients with primary nonfunction and other causes of graft dysfunction after liver transplantation in the era of extended criteria donor organs
No full textLiver dysfunction is an important cause of morbidity and mortality after orthotopic liver transplantation (OLT). The Molecular Adsorbent Recirculating System (MARS) is an albumin-based dialysis system designed to enhance the excretory function of a failing liver. MARS has been successfully used in patients affected by advanced liver disease and presenting with severe cholestasis. The aim of this study was to evaluate the safety and clinical efficacy of MARS in patients with liver dysfunction after OLT. Seven patients (primary nonfunction, 2 patients; graft dysfunction, 5 patients) fulfilled the inclusion criteria of serum bilirubin level >15 mg/dL and least 1 of the following clinical signs: hepatic encephalopathy (HE) > or = grade II, hepatorenal syndrome (HRS), and intractable pruritus. Graft and patient survival rates at 6 months were 42.8% and 57.1%, respectively. All patients tolerated MARS treatment, with no adverse event. In all patients, a decrease in serum bilirubin (P < .05), bile acids (P < .05), serum creatinine, and ammonia levels was observed after treatment with MARS. A considerable improvement of HE, as well as renal and synthetic liver functions, was observed in 4 of 5 patients with graft dysfunction, but not among those with primary nonfunction. The patients with intractable pruritus showed significant improvement of this symptom after MARS therapy. Thus, MARS is a safe, therapeutic option for the treatment of liver dysfunction after OLT. Further studies are necessary to confirm whether this treatment is able to improve both graft and patient survival
La Radioembolizzazione Arteriosa (TARE) nel Trattamento della Recidiva di Epatocarcinoma dopo Trapianto di Fegato
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