D-MELD, a Powerful Instrument To Optimize Donor-2-Recipient Match. Differences between US and Italy

A. Avolio, J. Halldorson, M. Lirosi, S. Agnes, M. Salizzoni, A. Pinna, M. Spada, L. De Carlis, M. Colledan, G. Gerunda, E. Andorno, G. Rossi, G. Ettorre, A. Risaliti, V. Mazzaferro, M. Rossi, G. Tisone, F. Zamboni, M. Vivarelli, L. Lupo, O. Cuomo, F. Calise, N. Nicolotti, A. Vitale, R. Romagnoli, A. Cucchetti, P. Bonsignore, I. Mangoni, D. Pinelli, R. Montalti, L. Caccamo, G. Vennarecci, D. Nicolini, E. Regalia, U. Baccarani, Q. Lai, T. Manzia, E. Tondolo, M. Rendina, A. Perrella, W. Santaniello, G. Bottino, G. Spagnoletti, G. Mariano, A. Gasbarrini, P. Burra, U. Cillo, the Donor-to-Recipient Italian Liver Transplant (DR2-ILTx) Study Group, Liver Transplant Centers

Div. of Organ's Transplantation, Catholic University, Rome
, UCSD
, Turin
, Bologna
, Palermo
, Milan
, Bergamo
, Modena
, Genua
, Ancona
, Udine
, Cagliari
, Bari
, Naples
, Padua

Meeting: 2013 American Transplant Congress

Abstract number: D1645

Previous studies demonstrated in US and Italy that D-MELD can be an instrument to optimize donor-2-recipient match (D2Rm) in Liver Transplantation.

To characterize prognostic power, peculiarities and differences in D2Rm, the UNOS database (db) and the Italian D-MELD db were merged. Pediatric cases, multi-organ Tx, SPLITs, living donor Tx, national share cases and DCD cases were excluded. 36.795 cases were recruited (US=31.569, ITALY=5226, 2002-2009 period).

Donor age (median, IQR) was lower in US than in Italy (43, 25-55 vs 56, 40-68), MELD was higher in US than in Italy (20, 14-28 vs 15, 11-21). D-MELD was similar. Low D-MELD class (<338) was prevalent in Italy while high D-MELD class (>1628) was prevalent in US.

Predictive factors of patient survival (PS) at Cox regression were: Recipient age 50-64 (HR 1.13, p=0.038) Recipient age >64 (HR 1.57, p<0.001) Race: caucasian vs black (HR 0.85, p<0.001) Acute liver failure (HR 1.79, p=0.001), HCV (HR 1.51, p<0.001), HBV (HR 0.75, p=0.003), Cholestasis (HR 1.52, p<0.001), DMELD class A vs class B (HR 0.72, p<0.001), DMELD class C vs class B (HR 1.77, p<0.001), Portal thrombosis (HR 1.28, p<0.001), Italy vs US (HR 0.90, p=0.007).

D2Rm expressed by D-MELD remains a strong predictor of PS. We suggest to avoid the allocation of a graft from an elderly donor to an high-MELD patient, especially if HCV+.

To cite this abstract in AMA style:

Avolio A, Halldorson J, Lirosi M, Agnes S, Salizzoni M, Pinna A, Spada M, Carlis LDe, Colledan M, Gerunda G, Andorno E, Rossi G, Ettorre G, Risaliti A, Mazzaferro V, Rossi M, Tisone G, Zamboni F, Vivarelli M, Lupo L, Cuomo O, Calise F, Nicolotti N, Vitale A, Romagnoli R, Cucchetti A, Bonsignore P, Mangoni I, Pinelli D, Montalti R, Caccamo L, Vennarecci G, Nicolini D, Regalia E, Baccarani U, Lai Q, Manzia T, Tondolo E, Rendina M, Perrella A, Santaniello W, Bottino G, Spagnoletti G, Mariano G, Gasbarrini A, Burra P, Cillo U, Centers LiverTransplant. D-MELD, a Powerful Instrument To Optimize Donor-2-Recipient Match. Differences between US and Italy [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/d-meld-a-powerful-instrument-to-optimize-donor-2-recipient-match-differences-between-us-and-italy/. Accessed May 17, 2025.

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