Impact of the New MELD-based Allocation System on Waiting List and Post-Transplant Survival - A Cohort Analysis Using the French National CRISTAL Database - Université Paris Cité Accéder directement au contenu
Article Dans Une Revue Transplant International Année : 2019

Impact of the New MELD-based Allocation System on Waiting List and Post-Transplant Survival - A Cohort Analysis Using the French National CRISTAL Database

Christan Jacquelinet
  • Fonction : Auteur
Olivier Soubrane
Jean-Yves Mabrut
  • Fonction : Auteur
Jérôme Dumortier
Vincent Leroy
Denis Pezet
  • Fonction : Auteur
Armand Abergel
François-René Pruvot
  • Fonction : Auteur
Camille Besh
  • Fonction : Auteur
Martine Neau Cransac
  • Fonction : Auteur
Pauline Houssel Debry
  • Fonction : Auteur

Résumé

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.

Dates et versions

hal-02862291 , version 1 (09-06-2020)

Identifiants

Citer

Carine Jasseron, Claire Francoz, Corinne Antoine, Camille Legeai, François Durand, et al.. Impact of the New MELD-based Allocation System on Waiting List and Post-Transplant Survival - A Cohort Analysis Using the French National CRISTAL Database. Transplant International, 2019, 32 (10), pp.1061--1073. ⟨10.1111/tri.13448⟩. ⟨hal-02862291⟩
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