Matching Graft Quality to Recipient's Disease Severity Based on the Survival Benefit in Liver Transplantation.

Scientific Reports
Audrey WinterPaul Landais

Abstract

Persistent shortage and heterogeneous quality of liver grafts encourages the optimization of donor-recipient matching in liver transplantation (LT). We explored whether or not there was a survival benefit (SB) of LT according to the quality of grafts assessed by the Donor Quality Index (DQI) and recipients' disease severity, using the Model for End-Stage Liver Disease (MELD) in 8387 French patients wait-listed between 2009 and 2014. SB associated with LT was estimated using the sequential stratification method in different categories of MELD and DQI. For each transplantation, a stratum was created that matched one transplanted patient with all eligible control candidates. Strata were thereafter combined, and a stratified Cox model, adjusted for covariates, was fitted in order to estimate hazard ratios that qualified the SB according to each MELD and DQI sub-group. A significant SB was observed for all MELD and DQI sub-groups, with the exception of high MELD patients transplanted with "high-risk" grafts. More specifically, in decompensated-cirrhosis patients, "high-risk" grafts did not appear to be detrimental in medium MELD patients. Interestingly, in hepatocellular-carcinoma (HCC) patients, a significant SB was found for all M...Continue Reading

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Citations

Jul 23, 2020·JHEP Reports : Innovation in Hepatology·Audrey WinterCyrille Féray
Jun 17, 2021·The American Surgeon·Jacob GuorguiFady M Kaldas
Jul 30, 2021·World Journal of Surgery·Chetana LimDaniel Azoulay

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