Abstract
Persistent shortage and heterogeneous quality of liver grafts encourages the optimization of donor-recipient matching in liver transplantation (LT). We explored whether or not there was a survival benefit (SB) of LT according to the quality of grafts assessed by the Donor Quality Index (DQI) and recipients’ disease severity, using the Model for End-Stage Liver Disease (MELD) in 8387 French patients wait-listed between 2009 and 2014. SB associated with LT was estimated using the sequential stratification method in different categories of MELD and DQI. For each transplantation, a stratum was created that matched one transplanted patient with all eligible control candidates. Strata were thereafter combined, and a stratified Cox model, adjusted for covariates, was fitted in order to estimate hazard ratios that qualified the SB according to each MELD and DQI sub-group. A significant SB was observed for all MELD and DQI sub-groups, with the exception of high MELD patients transplanted with “high-risk” grafts. More specifically, in decompensated-cirrhosis patients, “high-risk” grafts did not appear to be detrimental in medium MELD patients. Interestingly, in hepatocellular-carcinoma (HCC) patients, a significant SB was found for all MELD-DQI combinations. For MELD exceptions no SB was found. In terms of SB, “low-risk” grafts appeared appropriate for most severe patients (MELD > 30). Conversely, low/medium MELD and HCC patients presented an SB while allocated “high-risk” grafts. Thus, SB based matching rules for LT candidates might improve the survival of the LT population as a whole.
Highlights
Persistent shortage and heterogeneous quality of liver grafts encourages the optimization of donorrecipient matching in liver transplantation (LT)
In previous work[8], we performed an external validation of this score on our database, as well as the Eurotransplant-Donor Risk Index (ET-DRI)[9], according to the methodology proposed by Royston and Altman[10]
The survival benefit (SB) was estimated through hazard ratios (HRs) in each Model for End-Stage Liver Disease (MELD) and Donor Quality Index (DQI) category
Summary
Persistent shortage and heterogeneous quality of liver grafts encourages the optimization of donorrecipient matching in liver transplantation (LT). We explored whether or not there was a survival benefit (SB) of LT according to the quality of grafts assessed by the Donor Quality Index (DQI) and recipients’ disease severity, using the Model for End-Stage Liver Disease (MELD) in 8387 French patients waitlisted between 2009 and 2014. One of the main impediments to the use of these grafts is that guidelines for allocations are not clearly established and can vary between transplant centers and countries[3,4,5] If misused, these grafts could have a negative impact on patient survival and generate a significant increase in re-transplantation. The French allocation system, as in most countries, is based on a “sickest first” policy, according to the “Score foie”[12] This score takes into account the Model for End-Stage
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
