The MELD-based allocation system has been implemented in Germany in 2006 in order to decrease waiting list mortality in patients with end stage liver disease. However, the MELD score not only reflects the probability to die within 3 months, but simultaneously represents a major risk factor for post transplantation patient survival. Purpose of this study is to evaluate post-transplant results and waiting list mortality since the introduction of MELD-based allocation.

Liver transplant patients were assessed retrospectively from 2005 -2015 using our own center as well as open access Eurotransplant data. Differences in patient survival were calculated applying log-rank test. Statistical analysis was carried out using IBM SPSS Statisics 22.

From 2005 to 2015 1172 liver transplantations were performed in out department. The median Match-MELD at time of transplantation increased from 16 to 26 (Pearson r=0.69, p= 0.019). Existing pre-transplant outcome scores as well significantly increased in the investigated period (BAR-score, D-MELD and DRI, p<0.01, Spearman r= 0.1, 0.2 and 0.1 respectively). Concomitantly, 3-year patient survival decreased from 85% in 2005 to 70% in 2012 (Pearson r=-0.78, p= 0.022). Donation rate decreased from 14 in 2005 to 11 in 2017 per million inhabitants. Compensatory, during this time period, donor age increased from 48 to 54. Simultaneously, the number of transplantations per year dramatically decreased from 158 in 2005 to 79 in 2015 at our center, although the ratio of transplantations per reported liver donors steadily increased in Germany when compared to the whole Eurotransplant region. At the same time the ratio of waiting list mortality/active-listed patients increased significantly from 2007 to 2016 (Pearson r=0.69, p= 0.019), indicating an increased waiting list mortality.

The combination of increasing organ scarcity and MELD based allocation may require reconsideration of the current allocation policy and the inclusion of prognostic outcome factors should be discussed.

CITATION INFORMATION: Ritschl P., Wiering L., Aigner F., Biebl M., Eurich D., Schmelzle M., Sauer I., Kotsch K., Pratschke J., Öllinger R. MELD Based Allocation Deteriorates Patient Survival without Improving Waiting List Mortality in a Low Donor Area Am J Transplant. 2017;17 (suppl 3).

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