Balancing Outcome vs. Urgency in Modern Liver Transplantation

Dancs, Peter T.; Saner, Fuat;
GND
1204069379
LSF
54000
Benkö, Tamas; Molmenti, Ernesto P.;
GND
137554397
LSF
60128
Büchter, Matthias;
GND
1037421485
Zugehörige Organisation
General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
Paul, Andreas;
GND
140343342
Hoyer, Dieter P.

Background: Current allocation mechanisms for liver transplantation (LT) overemphasize emergency, leading to poorer longtime outcomes. The utility was introduced to recognized outcomes in allocation. Recently, Molinari proposed a predictive outcome model based on recipient data.

Aims: The aims of this study were to validate this model and to combine it with the utility to emphasize outcome in allocation.

Methods: We retrospectively analyzed 734 patients who were transplanted between January 2010 and December 2019. Points were assigned as in Molinari's model and the score sum was correlated with observed 90-day mortality. The utility was calculated as the product of 1-year survival times 3-month mortality on the waiting list. The weighting of different compounds was introduced, and utility curves were calculated. Model for End-Stage Liver Disease (MELD) scores according to maximal utility were determined.

Results: In total, 120 patients (16.3%) had died within 90 days after LT. Higher MELD score, obesity, and hemodialysis prior to LT were confirmed risk factors. Overall survival was 83.8 and 77.4% after 90 days and 12 months, respectively. General utility culminated at MELD scores >35 in the overall population. Emphasizing the outcome shifted the maximal utility to lower MELD scores depending on Molinari scores.

Conclusions: Emphasizing outcome, at least in certain recipient risk categories, might improve the longtime outcomes and might be integrated into allocation models.

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