1 Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. 2 Address correspondence to: Toru Ikegami, M.D., Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan.
Transplantation. 2014 Feb 27;97(4):457-62. doi: 10.1097/01.TP.0000435696.23525.d0.
Ensuring a good match between donor and recipient is critically important to achieve acceptable graft outcomes after living-donor liver transplantation (LDLT). Our objective was to evaluate the product of donor age and Model for End-stage Liver Disease score (D-MELD) as a predictor of graft survival after LDLT.
We retrospectively evaluated the records of 355 adults who underwent LDLT for chronic liver disease and explored the relationship between D-MELD and graft outcome.
High MELD score and advanced donor age were significantly associated with graft survival; D-MELD had the strongest association with in-hospital mortality. Receiver operating characteristic curve analysis showed that a D-MELD score of 462 had the highest sensitivity for predicting in-hospital mortality. Patients were allocated to three groups based on D-MELD (Class A [≤449; n=142], Class B [450-899; n=163], and Class C [≥900; n=50]) and were found to have stratified cumulative 2-year graft survivals of 94.1%, 85.3%, and 63.1%, respectively (P<0.01). Although D-MELD Class C patients had larger graft volume-to-standard liver volume ratio (P<0.01) and received right lobe grafts more often (P<0.01), they still exhibited significantly higher rates of primary graft dysfunction (P<0.01) and in-hospital mortality (P<0.01). Outcomes in D-MELD Class C were significantly worse in hepatitis C-positive patients (P<0.05).
The D-MELD score is a simple and reliable predictor of early graft survival that assists the matching of donors and recipients in LDLT in adults.
在活体肝移植（LDLT）后，确保供体和受体之间的良好匹配对于获得可接受的移植物效果至关重要。我们的目的是评估供体年龄和终末期肝病模型（MELD）评分的乘积（D-MELD）作为 LDLT 后移植物存活率的预测指标。
我们回顾性评估了 355 例接受 LDLT 治疗慢性肝病的成年人的记录，并探讨了 D-MELD 与移植物结局之间的关系。
高 MELD 评分和高龄供体与移植物存活率显著相关；D-MELD 与住院死亡率的相关性最强。受试者工作特征曲线分析显示，D-MELD 评分 462 预测住院死亡率的敏感性最高。根据 D-MELD 将患者分为三组（A 级[≤449；n=142]、B 级[450-899；n=163]和 C 级[≥900；n=50]），发现 2 年累积移植物存活率分别为 94.1%、85.3%和 63.1%（P<0.01）。尽管 D-MELD C 级患者的移植物体积与标准肝体积比更大（P<0.01）且更常接受右叶移植（P<0.01），但他们的原发性移植物功能障碍（P<0.01）和住院死亡率（P<0.01）仍显著更高。D-MELD C 级丙型肝炎阳性患者的结局明显更差（P<0.05）。
D-MELD 评分是一种简单可靠的早期移植物存活率预测指标，有助于在成人 LDLT 中进行供体和受体的匹配。
