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...
| Main Authors: | , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2020-06-01
|
| Series: | Journal of Clinical Medicine |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2077-0383/9/6/1929 |
| id |
doaj-4566fefd51c340a693cc3c1b73bb65a9 |
|---|---|
| record_format |
Article |
| collection |
DOAJ |
| language |
English |
| format |
Article |
| sources |
DOAJ |
| author |
Paul V. Ritschl Leke Wiering Tomasz Dziodzio Maximilian Jara Jochen Kruppa Uwe Schoeneberg Nathanael Raschzok Frederike Butz Brigitta Globke Philippa Seika Max Maurer Matthias Biebl Wenzel Schöning Moritz Schmelzle Igor M. Sauer Frank Tacke Robert Öllinger Johann Pratschke |
| spellingShingle |
Paul V. Ritschl Leke Wiering Tomasz Dziodzio Maximilian Jara Jochen Kruppa Uwe Schoeneberg Nathanael Raschzok Frederike Butz Brigitta Globke Philippa Seika Max Maurer Matthias Biebl Wenzel Schöning Moritz Schmelzle Igor M. Sauer Frank Tacke Robert Öllinger Johann Pratschke The Effects of MELD-Based Liver Allocation on Patient Survival and Waiting List Mortality in a Country with a Low Donation Rate Journal of Clinical Medicine liver transplantation allocation policy donor shortage organ donation Germany |
| author_facet |
Paul V. Ritschl Leke Wiering Tomasz Dziodzio Maximilian Jara Jochen Kruppa Uwe Schoeneberg Nathanael Raschzok Frederike Butz Brigitta Globke Philippa Seika Max Maurer Matthias Biebl Wenzel Schöning Moritz Schmelzle Igor M. Sauer Frank Tacke Robert Öllinger Johann Pratschke |
| author_sort |
Paul V. Ritschl |
| title |
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_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_sort |
effects of meld-based liver allocation on patient survival and waiting list mortality in a country with a low donation rate |
| publisher |
MDPI AG |
| series |
Journal of Clinical Medicine |
| issn |
2077-0383 |
| publishDate |
2020-06-01 |
| 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, <i>p</i> < 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 (<i>p</i> = 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, <i>p</i> < 0.001, CI = 0.634–0.977). In low-donation areas, MELD-based liver allocation may require reconsideration and inclusion of prognostic outcome factors. |
| topic |
liver transplantation allocation policy donor shortage organ donation Germany |
| url |
https://www.mdpi.com/2077-0383/9/6/1929 |
| work_keys_str_mv |
AT paulvritschl theeffectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT lekewiering theeffectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT tomaszdziodzio theeffectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT maximilianjara theeffectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT jochenkruppa theeffectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT uweschoeneberg theeffectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT nathanaelraschzok theeffectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT frederikebutz theeffectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT brigittaglobke theeffectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT philippaseika theeffectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT maxmaurer theeffectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT matthiasbiebl theeffectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT wenzelschoning theeffectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT moritzschmelzle theeffectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT igormsauer theeffectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT franktacke theeffectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT robertollinger theeffectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT johannpratschke theeffectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT paulvritschl effectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT lekewiering effectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT tomaszdziodzio effectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT maximilianjara effectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT jochenkruppa effectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT uweschoeneberg effectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT nathanaelraschzok effectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT frederikebutz effectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT brigittaglobke effectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT philippaseika effectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT maxmaurer effectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT matthiasbiebl effectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT wenzelschoning effectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT moritzschmelzle effectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT igormsauer effectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT franktacke effectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT robertollinger effectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate AT johannpratschke effectsofmeldbasedliverallocationonpatientsurvivalandwaitinglistmortalityinacountrywithalowdonationrate |
| _version_ |
1724687629546422272 |
| spelling |
doaj-4566fefd51c340a693cc3c1b73bb65a92020-11-25T03:02:56ZengMDPI AGJournal of Clinical Medicine2077-03832020-06-0191929192910.3390/jcm9061929The Effects of MELD-Based Liver Allocation on Patient Survival and Waiting List Mortality in a Country with a Low Donation RatePaul V. Ritschl0Leke Wiering1Tomasz Dziodzio2Maximilian Jara3Jochen Kruppa4Uwe Schoeneberg5Nathanael Raschzok6Frederike Butz7Brigitta Globke8Philippa Seika9Max Maurer10Matthias Biebl11Wenzel Schöning12Moritz Schmelzle13Igor M. Sauer14Frank Tacke15Robert Öllinger16Johann Pratschke17Department of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, GermanyDepartment of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, GermanyDepartment of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, GermanyDepartment of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, GermanyInstitute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, GermanyInstitute of Biometry and Clinical Epidemiology, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, GermanyDepartment of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, GermanyDepartment of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, GermanyDepartment of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, GermanyDepartment of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, GermanyDepartment of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, GermanyDepartment of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, GermanyDepartment of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, GermanyDepartment of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, GermanyDepartment of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, GermanyDepartment of Hepatology and Gastroenterology, Campus Charité-Mitte and Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, GermanyDepartment of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, GermanyDepartment of Surgery, Campus Charité Mitte, Campus Virchow-Klinikum, Charité—Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 10178 Berlin, GermanyThe 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, <i>p</i> < 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 (<i>p</i> = 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, <i>p</i> < 0.001, CI = 0.634–0.977). In low-donation areas, MELD-based liver allocation may require reconsideration and inclusion of prognostic outcome factors.https://www.mdpi.com/2077-0383/9/6/1929liver transplantationallocation policydonor shortageorgan donationGermany |