Title :

Impact 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 [Auteur]
Agence de la biomédecine [Saint-Denis la Plaine]
Francoz, Claire [Auteur]
Centre de recherche biomédicale Bichat-Beaujon [CRB3]
Antoine, Corinne [Auteur]
Agence de la biomédecine [Saint-Denis la Plaine]
Legeai, Camille [Auteur]
Agence de la biomédecine [Saint-Denis la Plaine]
Durand, Francois [Auteur]
Centre de recherche biomédicale Bichat-Beaujon [CRB3]
Dharancy, Sebastien [Auteur]
Lille Inflammation Research International Center - U 995 [LIRIC]

Journal title :

Transplant International

Abbreviated title :

Transpl. Int.

Volume number :

32

Pages :

1061-1073

Publication date :

2019-10

ISSN :

1432-2277

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

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 MELD score. The main objective ...
Show more >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 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% versus 76%; p=0.8) and one-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 one-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. This article is protected by copyright. All rights reserved.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

CHU Lille
Inserm
Université de Lille

Collections :

• Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286

Submission date :

2024-01-30T10:26:30Z
2024-03-22T15:05:58Z