Liver Posters

Tuesday July 03, 2018 from 16:30 to 17:30

Room: Hall 10 - Exhibition

P.858 DR-MELD: A new concept to predict graft survival after liver transplantation with aged donors

Carlos Jimenez, Spain

Hospital 12 de Octubre

Abstract

DR-MELD: A New Concept to Predict Graft Survival after Liver Transplantation with Aged Donors

Oscar Caso Maestro1, Iago Justo Alonso 1, Carlos Mu├▒oz1, Alberto Marcacuzco Quinto 1, Maria Garcia-Conde1, Jorge Calvo Pulido 1, Felix Cambra Molero 1, Alejandro Manrique Municio 1, Pilar Del Pozo Elso1, Alvaro Garcia Sesma 1, Anisa Nutu 1, Carlos Jimenez Romero 1.

1Hepatobiliary Surgery and Abdominal Organs Trasnaplantation, `12 de Octubre┬┤University Hospital, MAdrid, Spain

Introduction: The use of old grafts is one of the main sources to increase the number of available grafts for liver transplantation (LT). D-MELD seems to be the best graft survival predictor to date, but if we combine D-MELD with other variables maybe we can get a better score to predict survival. The aim of this study is analyse our experience in LT with donors >70 years, identify independent predictors of graft survival, and then, try to combine these predictors in an attempt to find a new score to predict graft survival.
Materials and Methods: We present a longitudinal and retrospective study of all LT performed in our department using grafts >70 years. Donor, recipient, LT complications, and short, medium and long-term follow-up variables were analyzed.
Results: From April 1986 to May 2016, 1848 LT were performed in 1659 patients. We performed 232 LT with grafts from donors >70 years, 20 cases were excluded, so 212 cases were included in the analysis. Donor median age was 76 years and 125 (59%) donors were females. We found hypertension in 122 (57,5%) donors and diabetes in 43 (20,3%). A biopsy was taken from all grafts during the procurement process, diffuse microsteatosis was described in 41 (19,5%) patients and mild steatosis in 56 (26,7%). Recipient median age was 59 years and 167 (78,8%) patients were males. The indication for LT was alcohol in 95 (44,8%) patients and HCV in 72 (34%) patients. Hepatocellular carcinoma (HCC) was diagnosed in 84 (39,3%) patients. Median recipient MELD score was 13 and median recipient D-MELD was 1051. Mean CIT was 445 minutes. After a mean follow-up of 64 months, PNF was present in 3,3%, acute rejection in 25%, vascular complications, in 6,6% biliary complications in 7,5% and liver re-transplantation was necessary in 12 (5,7%) patients. Finally, patient and graft survival at 5 years was 69% and 64.5%, respectively. In the multivariate analysis we identified as independent risk factors for a worse graft survival HCV, donor age, recipient age and D-MELD.  Searching a  new score to predict old livers surival, we multiply the D-MELD value and the recipient age (DR-MELD) and we applied the Kaplan-Meier method with the Log-Rank test to study the influence of this parameter on the graft survival. Mean DR-MELD value was 50.286 (range 4752-234.000). Graft survival at 5 years was 100% for DR-MELD <25.000, 76,2% for DR-MELD 25.000-50.000, 767,8% for DR-MELD 50.000-75.000, 52,1% for DR-MELD 75.000-100.000 and 49% for DR-MELD >100.000 (p<0,00).
Conclusion: DR-MELD seems to be a good predictor of graft survival after LT with donors >70 years and very easy to use in daily clinical practise.



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