Roman Liver Tx Allocation: Results at 48
months of an innovative regional allocation
model based on MELDNa and Donor-to-Recipient
Match
Federica Ferracci1, Alfonso W. Avolio1, Francesca R. Ponziani1,
Antonio Grieco1, Salvatore Agnes1, Stefano Ginanni
Corradini2, Fabio Melandro2, Flaminia Ferri2, Massimo Rossi2,
Tommaso M. Manzia3, Ilaria Lenci3, Matteo Manuelli3,
Mario Angelico3, Giuseppe Tisone3, Giovanni Vennarecci4,
Marco Colasanti4, Roberto L. Meniconi4, Ubaldo Visco Comandini4,
Giuseppe M. Ettorre4, Raffaella Zaccaria5, Nicola Torlone5,
Maurizio Valeri5; 1Transplant center - University Hospital
“A. Gemelli”, Rome, Italy; 2Transplant center - University Hospital
“Umberto I”, Rome, Italy; 3Transplant center - University
Hospital “Tor Vergata”, Rome, Italy; 4Transplant center - San
Camillo Hospital, Rome, Italy; 5Transplant center - Regione
Lazio, Rome, Italy
BACKGROUND Liver allocation policies are different
between Countries and regions. An innovative allocation
model based on MELDNa and donor age was developed
in Italy in a donor-to-recipient match perspective. 244
Liver transplants (LT) performed (2013-2015) in a 4 Center
regional Consortium were compared to 235 controls (2010-
2012). P&M In the 2013-2015 period, Standard Organs
(SO, N=151, 61,8%) were allocated to patients (pts) on a
common regional waiting list, based on MELDNa (5 classes:
>30, N=32, 13.2%; 29-24, N=41, 16.8%; 23-20, N=19, 7.8%;
19-15, N=24, 9.8%; <15, N=35, 14.3%). Non-SO (donor age
>65, N=76, 31.2%;other reasons, N=17, 6.9%) were allocated
locally, according to priority defined in each Center. and
to individual patient’s characteristics (mainly HCC pts
with progressive disease). In the 2010-2012 period each
Center used a MELD based allocation algorithm and HCC
pts were equipoised to non-HCC pts using the MELD 22
rule. Univariate Kaplan Meier (KM) and multivariate Cox
analyses (Cox) were used. RESULTS LT in 2013-2015 period
were older, with higher MELDNa, and received organs by
older donors. Regarding non-HCC patients: Recipient’s
age: 52±11 vs 50±11; Donor’s age: 51±18 vs 52±18; MELD
at LT: 23±7 vs 21±7, p=0.002; MELDNa at LT: 25±7 vs 22±7,
p=0.003. Regarding HCC patients: Recipient’s age: 58±6
vs 57±8; Donor’s age: 56±17 vs 52±18; MELD at LT: 15±6
vs 14±6; MELDNa at LT: 16±7 vs 15±5. Waiting time was
significantly lower for non-HCC group 2.0±4.4 vs 6.7±8.3
mo, p=0.0001, and unchanged for the HCC patients
5.7±5.2 vs 5.3±5. 48 mo patient survival was similar (KM:
overall 76% continuos l vs 79% dotted l; non-HCC: 78%
vs 80%; HCC: 73% vs 77%). MELDNa and recipient’s age
resulted significant prognostic predictors at Cox. CONCLUSIONS
Although overall survival was slightly reduced in the
non-SO HCC subgroup, the innovative allocation model
provides positive results about overall LT performed, using
organs from older donors, and faster transplantation for
pts with progressive liver disease
