Impact of the new MELD-based allocation system on waiting list and post-transplant survival - a cohort analysis using the French national CRISTAL database
Carine Jasseron, Claire Francoz, Corinne Antoine, Camille Legeai, François Durand, Sébastien Dharancy, collaborators, Christan Jacquelinet, Daniel Azoulay, Christophe Duvoux, Olivier Scatton, Yvon Calmus, Daniel Cherqui, Didier Samuel, François Durand, Olivier Soubrane, Jean-Yves Mabrut, Jérôme Dumortier, Christian Letoublon, Vincent Leroy, Denis Pezet, Armand Abergel, Antonio Iannelli, Rodolphe Anty, Francis Navarro, Georges Pageaux, François-René Pruvot, Sébastien Dharancy, Philippe Bachellier, Camille Besh, Georges Mantion, Vincent Di Martino, Nassim Kamar, Fabrice Muscari, Laurence Chiche, Martine Neau Cransac, Karim Boudjema, Pauline Houssel Debry, Ephrem Salame, Carine Jasseron, Claire Francoz, Corinne Antoine, Camille Legeai, François Durand, Sébastien Dharancy, collaborators, Christan Jacquelinet, Daniel Azoulay, Christophe Duvoux, Olivier Scatton, Yvon Calmus, Daniel Cherqui, Didier Samuel, François Durand, Olivier Soubrane, Jean-Yves Mabrut, Jérôme Dumortier, Christian Letoublon, Vincent Leroy, Denis Pezet, Armand Abergel, Antonio Iannelli, Rodolphe Anty, Francis Navarro, Georges Pageaux, François-René Pruvot, Sébastien Dharancy, Philippe Bachellier, Camille Besh, Georges Mantion, Vincent Di Martino, Nassim Kamar, Fabrice Muscari, Laurence Chiche, Martine Neau Cransac, Karim Boudjema, Pauline Houssel Debry, Ephrem Salame
Abstract
Concerns related to equity and efficacy of our previous center-based allocation system have led us to introduce a patient-based allocation system called the "Liver Score" that incorporates the MELD score. The main objective of this study was to compare waitlist and post-transplant survivals before and after implementation of the "Liver Score" using the French transplant registry (period before: 2004-2006 and period after: 2007-2012). Patients transplanted during the second period were sicker and had a higher MELD. One-year waitlist survival (74% versus 76%; p=0.8) and one-year post-transplant survival (86.3% vs 85.7%; p=0.5) were similar between the 2 periods. Cirrhotic recipients with MELD>35 had lower one-year post-transplant survival compared to those with MELD<35 (74.8% vs 86.3%; p<0.01), mainly explained by their higher intubation and renal failure rates. The MELD showed a poor discriminative capacity. In cirrhotic recipients with MELD>35, patients presenting 2 or 3 risk factors (dialysis, intubation or infection) had a lower 1-year survival compared to those with none of these risk factors (61.2% vs 92%; p<0.01). The implementation of the MELD-based allocation system has led to transplant sicker patients with no impact on waitlist and post-transplant survivals. Nevertheless, selection of patients with MELD>35 should be completed to allow safe transplantation. This article is protected by copyright. All rights reserved.
Keywords: Liver transplantation; MELD score; allocation system; discriminative capacity; survival.
This article is protected by copyright. All rights reserved.
Source: PubMed