524 POTENTIAL SURVIVAL BENEFIT OF THE 5-VARIABLE MODEL FOR END-STAGE LIVER DISEASE (5VMELD) FOR LIVER TRANSPLANT ALLOCATION

POSTERS recurrence-unrelated-censored survival was 78% in Group A and 88% in Group B (P = 0.028). Mean fibrosis progression/year was 0.82 in Group A and 0.43 in Group B (P = 0.2). Conclusion: Prolongation of AVT in non-responders to conventional treatment showed an overall beneficial effect and an acceptable tolerance rate. 524 POTENTIAL SURVIVAL BENEFIT OF THE 5-VARIABLE MODEL FOR END-STAGE LIVER DISEASE (5VMELD) FOR LIVER TRANSPLANT ALLOCATION R.P. Myers, A.A.M. Shaheen, P. Faris, A.I. Aspinall, K.W. Burak. Liver Unit, Division of Gastroenterology, University of Calgary, Calgary, AB, Canada E-mail: [email protected] Background: Modifications to MELD have been proposed to improve prioritization of liver transplant (LT) candidates. We recently developed a revised MELD including sodium and albumin (5vMELD) that improves prediction of waiting list mortality compared with MELD and MELDNa (Myers, Hepatology 2010; 52[4]: 375A). Our objectives were to examine potential survival benefits of a 5vMELD-based allocation system with a particular emphasis on low MELD (<15) candidates who may incur a significant risk of death in settings with prolonged waiting time. Methods: 15,114 adults registered on the LT waiting list in the U.S. between 2002 and 2007 were identified using the UNOS STAR database and categorized into low (<15) and high (≥15) MELD groups. The difference between 5vMELD and MELD was calculated and patients who would gain ≥10 points with 5vMELD were considered indicative of those who would have had a meaningful increase in the likelihood of LT had 5vMELD been in use. Results: In total, 1,113 patients (7%) died within 3 months of wait]ing list registration, 970 (13%) and 143 (2%) among the high and low MELD groups, respectively (P < 0.0005). Compared with low MELD patients who survived, deceased patients had significantly lower median serum albumin (2.8 vs. 3.3 g/dL) and sodium (136 vs. 138 mmol/L) concentrations (both P < 0.00005). Overall, the median difference between 5vMELD and MELD was 5 points (IQR 3–7). As demonstrated in the Figure, patients who died despite low MELD scores would have had the largest increase in points had a 5vMELDbased allocation policy been in place. Among low MELD decedents, 27% would have gained ≥10 points with 5vMELD versus only 4–7% in the other groups (all P < 0.0005). Similar, albeit smaller, advantages of 5vMELD over MELDNa were also observed (data not shown). Conclusions: A 5vMELD-based LT allocation system offers potential survival benefits compared with MELD, particularly among patients traditionally deemed to be at a low risk of waiting list mortality.

Table: MELD vs. 5vMELD among 1113 patients who died MELD

<10 10–19 20–29 30–39 40 Total

5vMELD <10

10–19

20–29

30–39

40

Total

6 − − − − 6

24 62 − − − 86

5 216 226 − − 447

− 3 166 253 − 422

− − − − 152 152

35 281 392 253 152 1113

525 EARLY CLINICAL AND ECONOMIC OUTCOMES OF LIVING LIVER DONORS IN THE UNITED STATES: A POPULATION-BASED STUDY R.P. Myers, A.A.M. Shaheen, K.W. Burak, E. Dixon. Liver Unit, Division of Gastroenterology, University of Calgary, Calgary, AB, Canada E-mail: [email protected] Background: Living donor liver transplantation (LDLT) is an effective strategy to maximize liver transplantation (LT), yet concerns regarding donor morbidity and mortality persist. Although donor safety data from case series and registries have been reported, national data are unavailable. Our objective was to study early clinical and economic outcomes among living liver donors from a population-based perspective. Methods: Adults (18–65 years) who underwent partial hepatectomy for LDLT in the U.S. between 1993 and 2007 were identified using the Nationwide Inpatient Sample database. The primary outcomes included in-hospital mortality, postoperative complications and secondary procedures. Lengths of stay (LOS) and hospital charges (adjusted to 2007 $USD) were also recorded. Logistic regression analyses examined patient and hospital predictors of complications including comorbidities (according to the Elixhauser algorithm), hospital volume for live donor and cadaveric LT (highest quartile vs. others), and year. Results: Between 1993 and 2007, 587 patients underwent partial hepatectomy for LDLT at 42 hospitals, corresponding to ~3,000 patients nationwide. The median age was 34 years (IQR 27–43) and 80% of patients had no comorbidities. Median LOS was 6.1 days (IQR 5.0–7.6) and total charges were $65,179 (IQR $46,858–95,087). No donor deaths were reported, but 24% of patients (n = 139) had postoperative complications, including 40 (7% overall) who required a secondary procedure. The most common complications were gastrointestinal (11%), pulmonary (5.3%), infectious (3.4%), and cardiovascular (1.8%). Fifty patients (1.7%) had a biliary complication requiring surgical (1.2%) or endoscopic (0.5%) intervention. Additional procedures included blood product transfusion (4.0%), repeat laparotomy (0.8%), paracentesis (0.7%), and chest tube insertion (0.4%). In a multivariate analysis that adjusted for age, sex, race, insurance, year, and hospital volume for live donor and cadaveric LT, only the presence of at least one comorbidity was associated with an increased risk of complications (odds ratio 1.68; 95% CI 1.06–2.68). Conclusions: This population-based, nationwide study suggests that living liver donation can be performed safely with low mortality, albeit a 24% rate of complications. Donation by patients with comorbid conditions is associated with a higher risk. This data provides valuable information for the informed consent process among potential living liver donors.

Figure: Diffference between 5vMELD and MELD. Journal of Hepatology 2011 vol. 54 | S209–S361

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