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The Effects of MELD-Based Liver Allocation on Patient Survival and Waiting List Mortality in a Country with a Low Donation Rate
The Model for End-Stage Liver Disease (MELD)-based allocation system was implemented in Germany in 2006 in order to reduce waiting list mortality. The purpose of this study was to evaluate post-transplant results and waiting list mortality since the introduction of MELD-based allocation in our cente...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356806/ https://www.ncbi.nlm.nih.gov/pubmed/32575598 http://dx.doi.org/10.3390/jcm9061929 |
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author | Ritschl, Paul V. Wiering, Leke Dziodzio, Tomasz Jara, Maximilian Kruppa, Jochen Schoeneberg, Uwe Raschzok, Nathanael Butz, Frederike Globke, Brigitta Seika, Philippa Maurer, Max Biebl, Matthias Schöning, Wenzel Schmelzle, Moritz Sauer, Igor M. Tacke, Frank Öllinger, Robert Pratschke, Johann |
author_facet | Ritschl, Paul V. Wiering, Leke Dziodzio, Tomasz Jara, Maximilian Kruppa, Jochen Schoeneberg, Uwe Raschzok, Nathanael Butz, Frederike Globke, Brigitta Seika, Philippa Maurer, Max Biebl, Matthias Schöning, Wenzel Schmelzle, Moritz Sauer, Igor M. Tacke, Frank Öllinger, Robert Pratschke, Johann |
author_sort | Ritschl, Paul V. |
collection | PubMed |
description | The Model for End-Stage Liver Disease (MELD)-based allocation system was implemented in Germany in 2006 in order to reduce waiting list mortality. The purpose of this study was to evaluate post-transplant results and waiting list mortality since the introduction of MELD-based allocation in our center and in Germany. Adult liver transplantation at the Charité—Universitätsmedizin Berlin was assessed retrospectively between 2005 and 2012. In addition, open access data from Eurotransplant (ET) and the German Organ Transplantation Foundation (DSO) were evaluated. In our department, 861 liver transplantations were performed from 2005 to 2012. The mean MELD score calculated with the laboratory values last transmitted to ET before organ offer (labMELD) at time of transplantation increased to 20.1 from 15.8 (Pearson’s R = 0.121, p < 0.001, confidence interval (CI) = 0.053–0.187). Simultaneously, the number of transplantations per year decreased from 139 in 2005 to 68 in 2012. In order to overcome this organ shortage the relative number of utilized liver donors in Germany has increased (85% versus 75% in non-German ET countries). Concomitantly, 5-year patient survival decreased from 79.9% in 2005 to 60.3% in 2012 (p = 0.048). At the same time, the ratio of waiting list mortality vs. active-listed patients nearly doubled in Germany (Spearman’s rho = 0.903, p < 0.001, CI = 0.634–0.977). In low-donation areas, MELD-based liver allocation may require reconsideration and inclusion of prognostic outcome factors. |
format | Online Article Text |
id | pubmed-7356806 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-73568062020-07-22 The Effects of MELD-Based Liver Allocation on Patient Survival and Waiting List Mortality in a Country with a Low Donation Rate Ritschl, Paul V. Wiering, Leke Dziodzio, Tomasz Jara, Maximilian Kruppa, Jochen Schoeneberg, Uwe Raschzok, Nathanael Butz, Frederike Globke, Brigitta Seika, Philippa Maurer, Max Biebl, Matthias Schöning, Wenzel Schmelzle, Moritz Sauer, Igor M. Tacke, Frank Öllinger, Robert Pratschke, Johann J Clin Med Article The Model for End-Stage Liver Disease (MELD)-based allocation system was implemented in Germany in 2006 in order to reduce waiting list mortality. The purpose of this study was to evaluate post-transplant results and waiting list mortality since the introduction of MELD-based allocation in our center and in Germany. Adult liver transplantation at the Charité—Universitätsmedizin Berlin was assessed retrospectively between 2005 and 2012. In addition, open access data from Eurotransplant (ET) and the German Organ Transplantation Foundation (DSO) were evaluated. In our department, 861 liver transplantations were performed from 2005 to 2012. The mean MELD score calculated with the laboratory values last transmitted to ET before organ offer (labMELD) at time of transplantation increased to 20.1 from 15.8 (Pearson’s R = 0.121, p < 0.001, confidence interval (CI) = 0.053–0.187). Simultaneously, the number of transplantations per year decreased from 139 in 2005 to 68 in 2012. In order to overcome this organ shortage the relative number of utilized liver donors in Germany has increased (85% versus 75% in non-German ET countries). Concomitantly, 5-year patient survival decreased from 79.9% in 2005 to 60.3% in 2012 (p = 0.048). At the same time, the ratio of waiting list mortality vs. active-listed patients nearly doubled in Germany (Spearman’s rho = 0.903, p < 0.001, CI = 0.634–0.977). In low-donation areas, MELD-based liver allocation may require reconsideration and inclusion of prognostic outcome factors. MDPI 2020-06-19 /pmc/articles/PMC7356806/ /pubmed/32575598 http://dx.doi.org/10.3390/jcm9061929 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Ritschl, Paul V. Wiering, Leke Dziodzio, Tomasz Jara, Maximilian Kruppa, Jochen Schoeneberg, Uwe Raschzok, Nathanael Butz, Frederike Globke, Brigitta Seika, Philippa Maurer, Max Biebl, Matthias Schöning, Wenzel Schmelzle, Moritz Sauer, Igor M. Tacke, Frank Öllinger, Robert Pratschke, Johann The Effects of MELD-Based Liver Allocation on Patient Survival and Waiting List Mortality in a Country with a Low Donation Rate |
title | The Effects of MELD-Based Liver Allocation on Patient Survival and Waiting List Mortality in a Country with a Low Donation Rate |
title_full | The Effects of MELD-Based Liver Allocation on Patient Survival and Waiting List Mortality in a Country with a Low Donation Rate |
title_fullStr | The Effects of MELD-Based Liver Allocation on Patient Survival and Waiting List Mortality in a Country with a Low Donation Rate |
title_full_unstemmed | The Effects of MELD-Based Liver Allocation on Patient Survival and Waiting List Mortality in a Country with a Low Donation Rate |
title_short | The Effects of MELD-Based Liver Allocation on Patient Survival and Waiting List Mortality in a Country with a Low Donation Rate |
title_sort | effects of meld-based liver allocation on patient survival and waiting list mortality in a country with a low donation rate |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7356806/ https://www.ncbi.nlm.nih.gov/pubmed/32575598 http://dx.doi.org/10.3390/jcm9061929 |
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