MELD -Na 15 and Lower – Way to Go Forward- DCD Liver Transplant or Wait for a Higher MELD Score ?
1Department of Surgery, Division of Liver and GI Transplantation, University of Miami, Miami, FL, 2University of Miami, Miami, FL, 3University of Miami/Jackson Memorial Hospital, Miami, FL
Meeting: 2022 American Transplant Congress
Abstract number: 897
Keywords: Donors, non-heart-beating
Topic: Clinical Science » Liver » 59 - Liver: Expanding the Donor Pool* (Liver: MELD Allocation / Donor Issues)
Session Information
Session Name: Liver: Expanding the Donor Pool* (Liver: MELD Allocation / Donor Issues)
Session Type: Poster Abstract
Date: Saturday, June 4, 2022
Session Time: 5:30pm-7:00pm
Presentation Time: 5:30pm-7:00pm
Location: Hynes Halls C & D
*Purpose: Liver transplantation following donation after cardiac death (DCD) continues to be a subject for heated debate, bigger controversy is if MELD score of 15 not sick enough for DCD liver transplant. Whereas OPTN data shows 47.1 % of listed patients with MELD -Na less than 15 at time of listing. We analyzed data of DCD donors for LT in order to identify risk factors for graft and patient survival.
*Methods: This was a retrospective cohort study using data reviewed by screening SRTR/UNOS of patients that underwent liver transplantation with DCD donor at Jackson Memorial Hospital in Miami, FL from 2017 to 2021. Different surrogates were analyzed, including donor, recipient, procurement and transplant operation characteristics. The primary outcome was patient and graft survival. Continuous variables were analyzed using a 2-sided student t-test. Categorical variables were presented as frequencies and proportion and compared using chi-squared or Fisher’s exact test as appropriate. Univariable Cox proportional hazards models were fit in order to assess the impact of individual covariables on the instantaneous rate of events, with time-to-event analysis also being ascertained through Kaplan-Meier estimates.
*Results: 54 cases were analyzed, liver only transplants, excluding SLKs .Alcoholic cirrhosis was the most prevalent etiology for liver disease. The 1-year survival rate following liver transplant using DCD donors was 90.7% (Figure 1). If separated by MELD score at the time of transplant, results showed a survival of 100% (15 patients) with MELD < 15 and 87% (39 patients) with MELD ≥ 15 (Figure 2). Furthermore, the subset of patients with a history of hepatocellular carcinoma (HCC) had also 100% survival at 12-month follow-up vs. 87% when compared with patients without the diagnosis of HCC.
*Conclusions: DCD donors are excellent options to increase the availability of organs for patients waiting for a LT. With close to 50% of the waitlist dominated by patient with MELD lower than 15 , successful use of DCD livers with 100 % patient survival is the way forward in future thereby , reducing the waitlist mortality and morbidity due to decompensations and prevent wait list drop outs .
To cite this abstract in AMA style:
Venkatasamy VVetrivel, Abreu P, Riella J, Shah R, Miyashiro R, Selvaggi G, Tekin A, Vianna R. MELD -Na 15 and Lower – Way to Go Forward- DCD Liver Transplant or Wait for a Higher MELD Score ? [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/meld-na-15-and-lower-way-to-go-forward-dcd-liver-transplant-or-wait-for-a-higher-meld-score/. Accessed November 23, 2024.« Back to 2022 American Transplant Congress