MELD-Based Allocation Leads to Inferior Survival After Liver Transplantation.
Department of Surgery, Campus Virchow and Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
Meeting: 2017 American Transplant Congress
Abstract number: 142
Keywords: Allocation, Donors, Liver, marginal, Survival
Session Information
Session Name: Concurrent Session: Liver Allocation, Utilization, and Machine Perfusion
Session Type: Concurrent Session
Date: Sunday, April 30, 2017
Session Time: 4:30pm-6:00pm
Presentation Time: 5:18pm-5:30pm
Location: E451a
Introduction and Background
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 graft and patient survival. Purpose of this study is to evaluate post transplant results and their development since the introduction of MELD-based allocation.
Methods
MELD scores at time of transplantation, 1- and 3-year graft- as well as patient survival were assessed from 2005 -2015 using our own and Eurotransplant data. Statistical analysis was carried out using Graphpad Prism 5.01.
Results
In our department 1172 liver transplantations were performed from 2005 to 2015. The average Lab-MELD at time of transplantation increased from 16.19 to 21.22 in this era (Pearson r=0.55, p= 0.078). The Match-MELD growth was even higher from 16.19 to 24.47 (Pearson r=0.68, p= 0.021). Concomitantly, while no significant changes were seen in 1-year survival over time, 3-year patient survival decreased from 85% in 2005 to 70% in 2012 (Pearson r=-0.78, p= 0.022). Similarly, in the Eurotransplant area the average 3-year patient survival was 77% in the years 2000-2006 and decreased to 72% in the period 2007-2012. In these years approximately 60 percent of all liver transplantations were performed in Germany. At our center, donor and/or recipient age have not significantly changed over the analyzed period, however the number of transplantations per year has dramatically decreased from 158 in 2005 to 79 in 2015 due to decreasing donor numbers in Germany (1185 in 2005 to 863 in 2015).
Conclusion
The implementation of MELD-based liver allocation in a country with a low donation rate has a dramatic impact on recipient survival after liver transplantation. Hence, under current circumstances MELD-based allocation may need reconsideration or at least modifications in Germany.
CITATION INFORMATION: Ritschl P, Wiering L, Hippler-Benscheidt M, Aigner F, Biebl M, Schmelzle M, Kotsch K, Pratschke J, Öllinger R. MELD-Based Allocation Leads to Inferior Survival After Liver Transplantation. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Ritschl P, Wiering L, Hippler-Benscheidt M, Aigner F, Biebl M, Schmelzle M, Kotsch K, Pratschke J, Öllinger R. MELD-Based Allocation Leads to Inferior Survival After Liver Transplantation. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/meld-based-allocation-leads-to-inferior-survival-after-liver-transplantation/. Accessed May 19, 2025.« Back to 2017 American Transplant Congress