Horst, M. ter (Matthijs) (2012) Donor Assessment Scores in Liver Transplantation : Relevance and Complete Irrelevance. thesis, Medicine.
Full text available on request.Abstract
Background: While the current liver allocation system based on MELD scores reduces waiting list mortality, it does not account for post-transplant outcome. Several donor assessment scores have been derived from national datasets to predict post-transplant outcome in order to assist transplant clinicians in matching the appropriate donor and recipient. Whether these tools accurately predict post-transplant outcome in a more specific patient cohort within a competitive environment is unknown. Methods: We calculated various donor assessment scores (the DRI, SOFT, and DMELD score) for each patient in a cohort of 414 patients that were transplanted between 1-1-2006 and 2-28-2011 at the Hospital of the University of Pennsylvania. Subsequently we compared the expected survival rates based on national datasets to the observed survival rates in the selected cohort. Ultimately, Kaplan-Meier survival analysis was performed to compare survival between the different group classifications of each donor assessment score. Results: Recipients were predominantly males. The male to female ratio was 3:1 (mean age 55 10.1 years; HCV 51.2%; HCC 37.4%). Recipients had an average calculated MELD score of 27.1 ± 6.1 at transplant. The average time spent on the waiting list was 1.1 ± 3.2 years. Donors were predominantly males. The mean donor age was 43.4 ± 17.9 years (Cause of death: CVA 44.4 %; Anoxia 27.1%, and Trauma 26.1%). The DRI, SOFT, and DMELD were good predictors of post-transplant outcome. Survival analysis showed significant survival differences between the different SOFT groups; however, no significant survival differences were demonstrated in the DRI and DMELD groups. Conclusion: Donor assessment scores are excellent predictors of post-transplant outcome, even at an aggressive transplant center within a competitive organ procurement organization (OPO). However, to promote the use of donor assessment scores in predicting post-transplant outcome, the allocation system has to change fundamentally into a system that also accounts for post-transplant outcome. Eventually, this change will enable transplant clinicians to truly match donors and recipients.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Porrett, Paige M. M.D. |
| Supervisor name: | External supervisor: and Porte, Prof. R.J. M.D. and Location: Hospital of the University of Pennsylvania, Philad |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:42 |
| Last Modified: | 25 Jun 2020 10:42 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/352 |
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