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• W2106307708 abstract "The efficacy of the Meld system to allocate livers has never been investigated in European centers. The outcome of 339 patients with chronic liver disease listed according to their Meld score between 2003 and 2005 (Meld era) was compared to 224 patients listed during the previous 2 years according to their Child score (Child era). During the Meld era, hepatocellular carcinomas (HCCs) had a ‘modified’ Meld based on their real Meld, waiting time and tumor stage. The dropouts were deaths, tumor progressions and too sick patients. The rate of removals from the list due to deaths and tumor progressions was significantly lower in the Meld than in the Child era: 10% and 1.2% versus 16.1% and 4.9%, p < 0.05. The 1-year patient survival on the list was significantly higher in the Meld era (84% vs. 72%, p < 0.05). The prevalence of transplantation for HCC increased from 20.5% in the Child to 48.9% in the Meld era (p < 0.001), but between HCCs and non-HCCs of this latter era the dropouts were comparable (9.4% vs. 14.9%, p = n.s.) as was the 1-year patient survival on the list (83% vs. 84%, p = n.s.). The Meld allocation system improved the outcome of patients with or without HCC on the list. The efficacy of the Meld system to allocate livers has never been investigated in European centers. The outcome of 339 patients with chronic liver disease listed according to their Meld score between 2003 and 2005 (Meld era) was compared to 224 patients listed during the previous 2 years according to their Child score (Child era). During the Meld era, hepatocellular carcinomas (HCCs) had a ‘modified’ Meld based on their real Meld, waiting time and tumor stage. The dropouts were deaths, tumor progressions and too sick patients. The rate of removals from the list due to deaths and tumor progressions was significantly lower in the Meld than in the Child era: 10% and 1.2% versus 16.1% and 4.9%, p < 0.05. The 1-year patient survival on the list was significantly higher in the Meld era (84% vs. 72%, p < 0.05). The prevalence of transplantation for HCC increased from 20.5% in the Child to 48.9% in the Meld era (p < 0.001), but between HCCs and non-HCCs of this latter era the dropouts were comparable (9.4% vs. 14.9%, p = n.s.) as was the 1-year patient survival on the list (83% vs. 84%, p = n.s.). The Meld allocation system improved the outcome of patients with or without HCC on the list. In the United States, deceased donor livers are allocated to patients with chronic liver disease with a priority based on the model for end-stage liver disease (Meld) (1Freeman RB Wiesner RH Harper A et al.UNOS/OPTN Liver Disease Severity Score, UNOS/OPTN Liver and Intestine, and UNOS/OPTN Pediatric Transplantation Committees. The new liver allocation system: Moving toward evidence-based transplantation policy..Liver Transpl. 2002; 8: 851-858Crossref PubMed Scopus (621) Google Scholar). As demonstrated in the United States, the Meld score provides a better prediction of mortality while on the waiting list than the Child score (2Pugh RN Murray-Lyon IM Dawson JL Pietroni MC Williams R Transection of the oesophagus for bleeding oesophageal varices..Br J Surg. 1973; 60: 646-649Crossref PubMed Scopus (6867) Google Scholar,3Wiesner R Edwards E Freeman R et al.United network for organ sharing liver disease severity score committee. Model for end-stage liver disease (MELD) and allocation of donor livers..Gastroenterology. 2003; 124: 91-96Abstract Full Text Full Text PDF PubMed Scopus (2004) Google Scholar) and it selects those patients with chronic liver disease better able to survive without liver transplantation (LT) during the waiting time. Due to the risk of dropout secondary to tumor progression (4Yao FY Bass NM Nikolai B et al.A follow-up analysis of the pattern and predictors of dropout from the waiting list for liver transplantation in patients with hepatocellular carcinoma: Implications for the current organ allocation policy..Liver Transpl. 2003; 9: 684-692Crossref PubMed Scopus (246) Google Scholar), patients with hepatocellular carcinoma (HCC) had an adjusted Meld score according to tumor stage: a score of 24 for T1 (5Marsh JW Dvorchik I Bonham CA Iwatsuki S Is the pathologic TNM staging system for patients with hepatoma predictive of outcome?.Cancer. 2000; 86: 538-543Crossref PubMed Scopus (207) Google Scholar) and 29 for T2. In the United States, these scores have subsequently been reduced to 20 and 24, respectively, in order to limit the high transplantation rate for HCC, after the first year of organ allocation based on the Meld policy (6Wiesner RH Freeman RB Mulligan DC Liver transplantation for hepatocellular cancer: The impact of the MELD allocation policy..Gastroenterology. 2004; 127: 61-67Abstract Full Text Full Text PDF Scopus (247) Google Scholar). Due to the significant increase in the number of patients listed for LT in recent years and in accordance with the data in the literature, our center changed the previous liver allocation system based on the Child classification toward the Meld score (7Ravaioli M Grazi GL Ercolani G et al.Liver allocation for hepatocellular carcinoma: A European center policy in the pre-MELD era..Transplantation. 2006; 81: 525-530Crossref PubMed Scopus (23) Google Scholar). Our purpose was to improve the selection of those recipients with the highest risk of being removed from the list. Differently from the US Meld score, patients with HCC did not have a fixed adjusted-Meld. The score was instead calculated by considering their real Meld score, the waiting time with tumor and the tumor stage. We report the 2 years experience of our center with the Meld system, comparing the results with a series of recipients listed in the previous 2 years, where patients were selected according to their Child score (7Ravaioli M Grazi GL Ercolani G et al.Liver allocation for hepatocellular carcinoma: A European center policy in the pre-MELD era..Transplantation. 2006; 81: 525-530Crossref PubMed Scopus (23) Google Scholar). We prospectively evaluated all patients on the waiting list for LT for chronic liver disease at the University of Bologna, Bologna, Italy, from March 2003, when our center started to apply the Meld score, to March 2005 (Meld era). The outcome of this study population was compared with those patients listed for chronic liver disease during the pre-Meld era, from March 2001 to March 2003, when recipients were selected for LT according to their Child score (Child era) and the dropout rate of patients with HCC was basically controlled with the use of marginal donors (7Ravaioli M Grazi GL Ercolani G et al.Liver allocation for hepatocellular carcinoma: A European center policy in the pre-MELD era..Transplantation. 2006; 81: 525-530Crossref PubMed Scopus (23) Google Scholar). The minimum criteria for placing adults on the liver transplant waiting list were those reported by the American Society of Transplant Physicians and the American Association for the Study of Liver Diseases (8Lucey MR Brown KA Everson GT et al.Minimal criteria for placement of adults on the liver transplant waiting list: A report of a national conference organized by the American Society of Transplant Physicians and the American Association for the study of liver diseases..Liver Transpl Surg. 1997; 3: 628-637Crossref PubMed Scopus (320) Google Scholar) in both eras. During the Child era, apart from ABO and body size matching, our organ allocation priority was based on the following criteria: (1) clinical characteristics of patients classified according to the Child score, (2) match between donor age over 60 years and preoperative diagnosis of HCC (7Ravaioli M Grazi GL Ercolani G et al.Liver allocation for hepatocellular carcinoma: A European center policy in the pre-MELD era..Transplantation. 2006; 81: 525-530Crossref PubMed Scopus (23) Google Scholar). During the Meld era, apart from ABO and body size matching, liver allocation priority was based on the real Meld score for patients without HCC and on the modified Meld score (Meld-H) for patients with HCC. The Meld score was calculated using serum creatinine, serum total bilirubin and the INR according to the formula (9Kamath PS Wiesner RH Malinchoc M et al.A model to predict survival in patients with end-stage liver disease..Hepatology. 2001; 33: 464-470Crossref PubMed Scopus (3837) Google Scholar) currently in use by UNOS (http://www.unos.org), and it was measured at the time of dropout, LT and end of the follow-up (10Bambha K Kim WR Kremers WK et al.Predicting survival among patients listed for liver transplantation: An assessment of serial MELD measurements..Am J Transplant. 2004; 4: 1798-1804Crossref PubMed Scopus (98) Google Scholar). The preoperative criteria of selection for HCC patients, the diagnostic work-up, the treatment while on the waiting list and the histological evaluation were fully presented and discussed in our previous studies (11Ravaioli M Grazi GL Ercolani G et al.Partial necrosis on hepatocellular carcinoma nodules facilitates tumor recurrence after liver transplantation..Transplantation. 2004; 78: 1780-1786Crossref PubMed Scopus (109) Google Scholar,12Ravaioli M Ercolani G Cescon M et al.Liver transplantation for hepatocellular carcinoma: Further considerations on selection criteria..Liver Transpl. 2004; 10: 1195-1202Crossref PubMed Scopus (86) Google Scholar). The scores added to the HCC patients' real Meld score to compute the Meld-H changed over the 2 years of Meld experience, due to a preliminary analysis, which is reported in the results section. The Meld-H score was therefore calculated differently between the first and second year of the Meld system. During the first year, the Meld-H score was computed in the following way: Real Meld score + 5 points for T1, 8 points for T2 or 12 points for T3 + 1 point × months on the waiting list with a diagnosis of HCC. During the second year, the Meld-H score was computed in the following way: real Meld score + 3 points for T1 or 6 for T2/T3 + 0.5 for T1 or 1 for T2/T3 × months on the waiting list with a diagnosis of HCC. Tumor stage T1 was a single HCC with a diameter ≤3 cm, while T2 was a single HCC with a diameter between 3 and 5 cm or multiple HCCs not more than 3 cm with a diameter ≤3 cm. Patients with T3 stage had a single HCC with a diameter ≤8 cm or two HCCs with a diameter ≤5 cm or multiple HCCs ≤5 with a diameter ≤4 cm, which after preoperative treatments were downstaged to T2 at the time of listing. Patients listed for re-LT or with a preoperative diagnosis of acute liver failure were excluded from the study, because they were placed on a national urgent waiting list and had a national priority as status 1. The principal aim of the study was to evaluate the efficacy of organ allocation based on the Meld score and on the Meld score modified for HCC, as proposed by our center. The study was approved by the local institutional review committee. Statistical analyses were performed using Fisher's exact test, the Mann-Whitney test or the chi-square test, as appropriate. The survival of patients on the list was calculated by the Kaplan-Meier method starting from the day when patients were listed to the day of dropout, LT and the end of the follow-up period if they were still on the list. Dropouts included deaths while on the list, tumor progressions exceeding the transplant criteria and too sick cases, no longer suitable for transplantation. The survival of patients after LT was calculated by the Kaplan-Meier method starting from the day of LT to the day of death or to the most recent follow-up visit. The follow-up of patients in the Child era started in March 2001 and finished in March 2003 and for those in the Meld era it started in March 2003 and finished in March 2005. Differences were compared by the log-rank test and variables were evaluated in the multivariate analysis using Cox's proportional hazard model. The waiting time was computed from the date when patients were listed to the date of one of the following events: LT, death, exclusion from the waiting list or the end of the follow-up period if they were still on the waiting list. Among the dropouts from the list, the deaths while on the list and the removals from the list for tumor progression or because the patient was too sick were computed. When the dropout rate was calculated at 6 months, patients transplanted within 6 months were excluded from the analysis (13Ruf AE Kremers KW Chavez LL Descalzi VI Podesta LG Villamil FG Additional of serum sodium into MELD score predicts waiting list mortality better than MELD alone..Liver Transpl. 2005; 11: 336-343Crossref PubMed Scopus (350) Google Scholar,14Biggins SW Rodriguez HJ Bacchetti P Bass NM Roberts JP Terrault NA Serum sodium predicts mortality in patients listed for liver transplantation..Hepatology. 2005; 41: 32-39Crossref PubMed Scopus (323) Google Scholar). Logistic regression was used to assess the accuracy of variables as predictors of dropout. The concordance statistic (c-statistic), which is the equivalent of the area under the receiver operating characteristic (ROC) curves, was also calculated and the areas under the ROC curves were statistically compared (14Biggins SW Rodriguez HJ Bacchetti P Bass NM Roberts JP Terrault NA Serum sodium predicts mortality in patients listed for liver transplantation..Hepatology. 2005; 41: 32-39Crossref PubMed Scopus (323) Google Scholar, 15DeLong ER DeLong DM Clarke-Pearson DL Comparing the areas under two or more correlated receiver operating characteristic curves: A nonparametric approach..Biometrics. 1988; 44: 837-845Crossref PubMed Scopus (14634) Google Scholar, 16Hanley JA McNeil BJ The meaning and use of the area under a receiver operating characteristic (ROC) curve..Radiology. 1982; 143: 29-36Crossref PubMed Scopus (16264) Google Scholar, 17Hanley JA McNeil BJ A method of comparing the areas under receiver operating characteristic curves derived from the same cases..Radiology. 1983; 148: 839-843Crossref PubMed Scopus (6051) Google Scholar). Differences were considered significant for p values less than 0.05. Statistical analysis was performed with SPSS (SPSS Base 10.0; Application Guide, SPSS Inc., Chicago, USA, 1998). The mean age of patients (53.1 ± 8.9 years) and the sex (males 70.4%) was comparable between the two periods, while the prevalence of cases with the preoperative diagnosis of HCC was higher in the Meld than in the Child era (34.5% vs. 25.9%, p < 0.05). Patient outcome on the list together with the respective preoperative diagnosis, waiting time, Childand Meld score are reported in Table 1.Table 1Patient outcome on the list with the respective preoperative diagnosis, waiting time, Child and Meld scoresChild 224 patientsMeld 339 patientspLTs127 (56.7%)135 (39.8%)<0.005On the list47 (21%)160 (47.2%)<0.001Dropouts51 (22.8%)44 (13%)<0.005Deaths36 (16.1%)34 (10%)<0.05Too sick4 (1.8%)6 (1.8%)N.S.Tumor progressions11 (4.9%)4 (1.2%)<0.05LTsMedian waiting time days159103<0.05Median Child1111N.S.Median Meld1819<0.05HCC prevalence26 (20.5%)66 (48.9%)<0.001DropoutsMedian waiting time days10994N.S.Median Child1011N.S.Median Meld1821N.S.HCC prevalence17 (34%)11 (25%)N.S.On the listMedian waiting time days253267N.S.Median Child109N.S.Median Meld17140.089HCC prevalence15 (31.9%)40 (25%)N.S. Open table in a new tab At the time of transplantation the real median Meld score was significantly higher in the Meld than in the Child era (19 vs. 18, p < 0.05). Among transplanted patients (135 in the Meld era and 127 in the Child era), the prevalence of cases with a preoperative diagnosis of HCC was significantly higher in the Meld than in the Child era (48.9% vs. 20.5%, p < 0.001). In the Child era patients had priority for LT according to their Child score (c-statistic = 0.601, p < 0.01), while during the Meld era patients had priority for LT according to their Meld score (c-statistic = 0.689, p < 0.001). The survival rate of patients on the list was significantly higher in the Meld than in the Child era, as reported in Figure 1 and the risk of dropout per patient day on the waiting list was 1.75 times higher in the Child than in the Meld era; confidence intervals (CI) 1.17–2.63, p < 0.01. The risk of dropout divided per period and per category of Meld score is reported in Table 2.Table 2The risk of dropout divided per period and per category of Meld scoreChild era survival on the listMeld era survival on the listHRCIp3-months6-months3-months6-monthsAll cases89%84%93%89%1.751.17–2.63<0.01No. patients at risk 563 (224/339)159104228163Meld ≤2093%89%97%94%2.361.31–4.24<0.005No. patients at risk 380 (149/231)10978175120Meld 21–3088%84%85%80%0.960.49–1.88N.S.No. patients at risk 155 (65/90)47274734Meld >3045%23%79%70%3.781.11–12.95<0.05No. patients at risk 28 (10/18)42108HR = hazard ratio; CI = confidence intervals. Open table in a new tab HR = hazard ratio; CI = confidence intervals. The 6-month dropout rate was significantly higher in the Child than in the Meld era (22.3% vs. 12.5%, respectively, p < 0.05). Among HCC patients the 6-month dropout rate was 25.8% in the Child era and 9.1% in the Meld era (p < 0.05) and among non-HCC patients the 6-month dropout rate was 21.2% in the Child era and 13.9% in the Meld era (p < 0.05). During the Meld era, HCC patients had a score based on their real Meld score, waiting time with tumor and tumor stage, as previously reported. Due to this correction, their real Meld score increased from a median value of 15 (mean 16 ± 6, range 6–42) to 25 (mean 27 ± 8, range 13–58). The median score added for the waiting time with tumor was 4 points and 6 points for the tumor stage. The scores added were significantly related to the risk of being removed from the list for tumor progression (c-statistic = 0.714, p < 0.01). During the first 6 months of Meld experience with this policy, we observed a high rate of transplantation for HCC (64.7%) and no case of tumor progression for HCC; according to these data the scores added to the HCC patients were reduced as reported in the methods section. During the Child era, HCC patients did not have any additional priority, but they were considered more often for donors aged over 60 years, which were utilized more frequently in these patients (61.5% vs. 39.6%, p < 0.05). In the Meld era donors aged over 60 years were equally distributed among HCC and non-HCC patients (51.5% vs. 58%, p = n.s.). During the Meld era, the dropout rate was comparable between HCC and non-HCC patients: 9.4% and 14.9%, p = n.s. Among the 117 recipients listed with a preoperative diagnosis of HCC, 7 (6%) patients died while on the list due to liver failure and four (3.4%) cases were removed due to tumor progression. The real Meld score was related to the risk of death on the list in the non-HCC patients (c-statistic = 0.716, p < 0.05), but also in the HCC patients (c-statistic = 0.727, p < 0.001). The survival rate on the list was comparable between HCC and non-HCC cases as reported in Figure 2. The c-statistics of the ROC curves predict that the dropouts were 0.579 for Child, 0.637 for Meld and 0.644 for Meld-H, as reported in Figure 3. The statistical comparison of the areas under the ROC curves showed: Child versus Meld, p < 0.05; Child versus Meld-H, p < 0.05; Meld versus Meld-H, p = n.s. During the Meld era, the 1- and 2-year patient survival rates after LT were 91.8% and 85%, respectively. The survival rates were comparable between HCC and non-HCC patients. Univariate and multivariate analysis showed that real Meld, Meld-H and Child scores did not correlate with patient survival after LT using the variables as continuous or with variable cutoffs. The present study provides validation of the prognostic value of the Meld score, previously reported in the United States (6Wiesner RH Freeman RB Mulligan DC Liver transplantation for hepatocellular cancer: The impact of the MELD allocation policy..Gastroenterology. 2004; 127: 61-67Abstract Full Text Full Text PDF Scopus (247) Google Scholar,10Bambha K Kim WR Kremers WK et al.Predicting survival among patients listed for liver transplantation: An assessment of serial MELD measurements..Am J Transplant. 2004; 4: 1798-1804Crossref PubMed Scopus (98) Google Scholar,14Biggins SW Rodriguez HJ Bacchetti P Bass NM Roberts JP Terrault NA Serum sodium predicts mortality in patients listed for liver transplantation..Hepatology. 2005; 41: 32-39Crossref PubMed Scopus (323) Google Scholar,18Sharma P Balan V Hernandez JL et al.Liver transplantation for hepatocellular carcinoma: The MELD impact..Liver Transpl. 2004; 10: 36-41Crossref PubMed Scopus (214) Google Scholar, 19Yao FY Bass NM Ascher NL Roberts JP Liver transplantation for hepatocellular carcinoma: Lessons from the first year under the model of end-stage liver disease (MELD) organ allocation policy..Liver Transpl. 2004; 10: 621-630Crossref PubMed Scopus (93) Google Scholar, 20Olthoff KM Brown Jr, RS Delmonico FL et al.Summary report of a national conference: Evolving concepts in liver allocation in the MELD and PELD era..Liver Transpl. 2004; 10: 6-22Crossref PubMed Google Scholar ), in predicting the dropout rate from the waiting list in a European series. Furthermore the LT priority for HCC according to the modified Meld score, proposed by our center, proved to be a means of measuring the medical urgency for liver allocation in HCC patients, without increasing the removals from the list in the non-HCC group. In accordance with the data reported in the literature and due to the increasing number of patients on the waiting list, our center changed its previous liver allocation system. In the preMeld era, we selected recipients for LT on the basis of their Child score and the HCC dropouts were controlled by offering them marginal grafts more often (7Ravaioli M Grazi GL Ercolani G et al.Liver allocation for hepatocellular carcinoma: A European center policy in the pre-MELD era..Transplantation. 2006; 81: 525-530Crossref PubMed Scopus (23) Google Scholar). Since March 2003, recipients were placed on the waiting list according to their Meld score and HCC patients had a special score depending on their tumor stage, waiting time with tumor and real Meld score. We supposed that HCC patients with the same tumor stage, but with a different liver function and a different waiting time, had a different dropout risk. We therefore introduced a modified Meld score for them, based on the combination of these three variables. Due to the absence of previous experience, our model was empiric and to avoid any disadvantage to non-HCC patients, the data obtained by following this policy were frequently analyzed and the scores for HCC were changed according to the results. We believe this method is the only way to manage the removals from the list, which change over the years according to the number of patients listed and their clinical status. In some European centers the Meld score was found to be related to the prognosis of patients with liver cirrhosis (21Botta F Giannini E Romagnoli P et al.MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: A European study..Gut. 2003; 52: 134-139Crossref PubMed Scopus (282) Google Scholar,22Giannini E Botta F Fumagalli A et al.Can inclusion of serum creatinine values improve the Child-Turcotte-Pugh score and challenge the prognostic yield of the model for end-stage liver disease score in the short-term prognostic assessment of cirrhotic patients?.Liver Int. 2004; 24: 465-470Crossref PubMed Scopus (27) Google Scholar), but no study has been published concerning the efficacy of the Meld score in the selection of recipients on the waiting list. Therefore, to assay the efficacy of our prospective experience with Meld scores, we compared the data of 2 years of prospective experience with the data of patients listed in the two previous years. The comparison of these two periods showed that we were able to improve the survival of patients on the list during the Meld era (Figure 1) and this was more relevant for patients with high Meld scores (Table 2). This result was due to a lower rate of removals from the list for deaths and tumor progressions. Our allocation policy completely changed the fate of patients with HCC: in the Child era their dropouts were managed by offering them marginal grafts more often, while in the Meld era they had a modified Meld score, which assigned priority according to their tumor stage, waiting time and real Meld score. The first consequence of this policy was the increased rate of transplantation for HCCs, as described in the initial American experiences (6Wiesner RH Freeman RB Mulligan DC Liver transplantation for hepatocellular cancer: The impact of the MELD allocation policy..Gastroenterology. 2004; 127: 61-67Abstract Full Text Full Text PDF Scopus (247) Google Scholar,20Olthoff KM Brown Jr, RS Delmonico FL et al.Summary report of a national conference: Evolving concepts in liver allocation in the MELD and PELD era..Liver Transpl. 2004; 10: 6-22Crossref PubMed Google Scholar). Due to this result, present after the first 6 months of our activity in the Meld era, we reduced the scores added to the HCC patients according to their tumor stage and waiting time with tumor, as reported in the methods section. By following this policy, we maintained a comparable dropout rate between HCC and non-HCC patients and consequently their survival on the list was similar. The purpose of our score applied to HCC patients was to prevent the deaths due to liver failure and the removals for tumor progression. The real Meld score worked well for HCC patients and for non-HCC patients in predicting the deaths on the list, and our additional score was well related to the prediction of tumor progressions. Patients with cancer on the list have an addition risk of being removed due to tumor progression, but at the same time they may die due to liver failure like non-HCC patients. We therefore believe it correct to maintain a common score for these two types of recipients, which predicts the deaths on the list (the real Meld score), and to add additional points to HCC patients to predict the additional risk of dropout related to the presence of tumor. The mathematical formula to calculate this score is probably impossible to compile, because the removals from the list depend on the number of patients listed, on the donors available and on the clinical status of the recipients. Our policy was to adapt the additional scores for HCC patients, according to the yearly dropout results, in order to maintain a similar risk of being removed from the list between patients with and without a tumor. This solution seemed to be the best way to manage the removals from the list in our single center experience. The last issue to consider was the potentially worse outcome after LT in recipients selected with the highest Meld scores, reported by some authors and contradicted by others (23Jacob M Copley LP Lewsey JD et al.Pretransplant MELD score and post liver transplantation survival in the UK and Ireland..Liver Transpl. 2004; 10: 903-907Crossref PubMed Scopus (115) Google Scholar, 24Stell DA McAlister VC Thorburn D A comparison of disease severity and survival rates after liver transplantation in the United Kingdom, Canada, and the United States..Liver Transpl. 2004; 10: 898-902Crossref PubMed Scopus (29) Google Scholar, 25Onaca NN Levy MF Netto GJ et al.Pretransplant MELD score as a predictor of outcome after liver transplantation for chronic hepatitis C..Am J Transplant. 2003; 3: 626-630Crossref PubMed Scopus (64) Google Scholar, 26Kremers WK van IJperen M Kim WR et al.MELD score as a predictor of pretransplant and posttransplant survival in OPTN/UNOS status 1 patients..Hepatology. 2004; 39: 764-769Crossref PubMed Scopus (188) Google Scholar, 27Desai NM Mange KC Crawford MD et al.Predicting outcome after liver transplantation: Utility of the model for end-stage disease and newly derived discrimination function..Transplantation. 2004; 77: 99-106Crossref PubMed Scopus (216) Google Scholar, 28Roberts MS Angus DC Bryce CL Valenta Z Weissfeld L Survival after liver transplantation in the United States: A disease-specific analysis for the UNOS database..Liver Transpl. 2004; 10: 886-897Crossref PubMed Scopus (315) Google Scholar). The results of the Meld era showed no relationship between theoutcome after LT and the Meld score of recipients, but the analysis was performed with only 135 cases and further liver transplants are therefore needed to confirm these data. In conclusion, this European series confirmed that the Meld score was an effective parameter for predicting the deaths on the list of patients with and without HCC and it should be applied in the liver allocation system of European transplant centers. Our proposal of adding additional points to the real Meld score of HCC patients, according to their tumor stage and waiting time with tumor, was effective in our experience in controlling the dropouts for tumor progression and it could be a reasonable working method for other centers. Further prospective multicentric European studies will be needed to confirm our findings, which had the statistical bias of a single center experience." @default.
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• W2106307708 date "2006-07-01" @default.
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• W2106307708 title "Liver Transplantation with the Meld System: A Prospective Study from a Single European Center" @default.
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• W2106307708 doi "https://doi.org/10.1111/j.1600-6143.2006.01354.x" @default.
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