Open AccessImpact of the new MELD‐based allocation system on waiting list and post‐transplant survival—a cohort analysis using the French national CRISTAL database
Author(s) -
Jasseron Carine,
Francoz Claire,
Antoine Corinne,
Legeai Camille,
Durand François,
Dharancy Sébastien
Publication year - 2019
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13448
Subject(s) - medicine , liver transplantation , model for end stage liver disease , cohort , dialysis , overall survival , transplantation , united network for organ sharing , database , computer science
Summary 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 model for end‐stage liver disease ( 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% vs. 76%; P = 0.8) and 1‐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 1‐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.