Are there better guidelines for allocation in liver transplantation? A novel score targeting justice and utility in the model for end-stage liver disease era

Philipp Dutkowski, Christian E. Oberkofler, Ksenija Slankamenac, Milo A. Puhan, Erik Schadde, Beat Müllhaupt, Andreas Geier, Pierre A. Clavien

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: To design a new score on risk assessment for orthotopic liver transplantation (OLT) based on both donor and recipient parameters. BACKGROUND: The balance of waiting list mortality and posttransplant outcome remains a difficult task in the era of the model for end-stage liver disease (MELD). METHODS: Using the United Network for Organ Sharing database, a risk analysis was performed in adult recipients of OLT in the United States of America between 2002 and 2010 (n = 37,255). Living donor-, partial-, or combined-, and donation after cardiac death liver transplants were excluded. Next, a risk score was calculated (balance of risk score, BAR score) on the basis of logistic regression factors, and validated using our own OLT database (n = 233). Finally, the new score was compared with other prediction systems including donor risk index, survival outcome following liver transplantation, donor-age combined with MELD, and MELD score alone. RESULTS: Six strongest predictors of posttransplant survival were identified: recipient MELD score, cold ischemia time, recipient age, donor age, previous OLT, and life support dependence prior to transplant. The new balance of risk score stratified recipients best in terms of patient survival in the United Network for Organ Sharing data, as in our European population. CONCLUSIONS: The BAR system provides a new, simple and reliable tool to detect unfavorable combinations of donor and recipient factors, and is readily available before decision making of accepting or not an organ for a specific recipient. This score may offer great potential for better justice and utility, as it revealed to be superior to recent developed other prediction scores.

Original languageEnglish (US)
Pages (from-to)745-753
Number of pages9
JournalAnnals of Surgery
Volume254
Issue number5
DOIs
StatePublished - Nov 2011

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End Stage Liver Disease
Social Justice
Liver Transplantation
Tissue Donors
Guidelines
Survival
Databases
Transplants
Cold Ischemia
Waiting Lists
Information Dissemination
Living Donors
Decision Making
Logistic Models
Mortality
Liver
Population

ASJC Scopus subject areas

  • Surgery

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Are there better guidelines for allocation in liver transplantation? A novel score targeting justice and utility in the model for end-stage liver disease era. / Dutkowski, Philipp; Oberkofler, Christian E.; Slankamenac, Ksenija; Puhan, Milo A.; Schadde, Erik; Müllhaupt, Beat; Geier, Andreas; Clavien, Pierre A.

In: Annals of Surgery, Vol. 254, No. 5, 11.2011, p. 745-753.

Research output: Contribution to journalArticle

Dutkowski, P, Oberkofler, CE, Slankamenac, K, Puhan, MA, Schadde, E, Müllhaupt, B, Geier, A & Clavien, PA 2011, 'Are there better guidelines for allocation in liver transplantation? A novel score targeting justice and utility in the model for end-stage liver disease era', Annals of Surgery, vol. 254, no. 5, pp. 745-753. https://doi.org/10.1097/SLA.0b013e3182365081
Dutkowski, Philipp ; Oberkofler, Christian E. ; Slankamenac, Ksenija ; Puhan, Milo A. ; Schadde, Erik ; Müllhaupt, Beat ; Geier, Andreas ; Clavien, Pierre A. / Are there better guidelines for allocation in liver transplantation? A novel score targeting justice and utility in the model for end-stage liver disease era. In: Annals of Surgery. 2011 ; Vol. 254, No. 5. pp. 745-753.
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