Halldorson JB, Jr RLC, Bhattacharya R, Bakthavatsalam R, Liou IW, Dick AA, Reyes JD, Perkins JD. D-MELD risk capping improves post-transplant and overall mortality under markov microsimulation. World J Transplant 2014; 4(3): 206-215 [PMID: 25346894 DOI: 10.5500/wjt.v4.i3.206]
Corresponding Author of This Article
Jeffrey B Halldorson, MD, Division of Transplant Surgery, Department of Surgery, University of California, Suite 2-286, 200 West Arbor Drive, #8401, San Diego, CA 92103-8401, United States. jhalldorson@ucsd.edu
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Sep 24, 2014; 4(3): 206-215 Published online Sep 24, 2014. doi: 10.5500/wjt.v4.i3.206
D-MELD risk capping improves post-transplant and overall mortality under markov microsimulation
Jeffrey B Halldorson, Robert L Carithers Jr, Renuka Bhattacharya, Ramasamy Bakthavatsalam, Iris W Liou, Andre A Dick, Jorge D Reyes, James D Perkins
Jeffrey B Halldorson, Division of Transplant Surgery, Department of Surgery, University of California, San Diego, CA 92103-8401, United States
Robert L Carithers Jr, Renuka Bhattacharya, Iris W Liou, Division of Transplantation, Department of Surgery, University of Washington, Seattle, WA 98195, United States
Ramasamy Bakthavatsalam, Andre A Dick, Jorge D Reyes, James D Perkins, Division of Gastroenterology, Department of Medicine, University of Washington, Seattle, WA 98195, United States
Author contributions: Halldorson JB, Carithers Jr RL, Reyes JD and Perkins JD designed the research; Halldorson JB and Perkins JD performed the research; Halldorson JB, Carithers Jr RL, Bhattacharya R, Bakthavatsalam R, Liou IW, Dick AA, Reyes JD and Perkins JD performed acquisition and interpretation of data; Halldorson JB wrote the manuscript; Carithers Jr RL, Bhattacharya R, Bakthavatsalam R, Liou IW, Dick AA, Reyes JD and Perkins JD provided assistance drafting the manuscript, provided critical reading leading to revisions of the manuscript and gave final approval of the version to be published.
Correspondence to: Jeffrey B Halldorson, MD, Division of Transplant Surgery, Department of Surgery, University of California, Suite 2-286, 200 West Arbor Drive, #8401, San Diego, CA 92103-8401, United States. jhalldorson@ucsd.edu
Telephone: +1-619-5433493 Fax: +1-619-5437785
Received: January 9, 2014 Revised: July 9, 2014 Accepted: July 18, 2014 Published online: September 24, 2014
Core Tip
Core tip: Optimal matching between donor livers and recipients balances recipient need with optimal utility. The product of calculated Model for End-Stage Liver Disease score excluding exception points and donor age (D-MELD) risk cap uniquely utilizes ethically neutral donor/recipient factors while maintaining predictive power, making it useful for donor/recipient matching paradigms aimed at improving utility. Described is a novel utilization of the D-MELD risk cap as an aid for donor/recipient matching. Markov modeling suggests that this paradigm improves outcomes both by decreasing futile transplantations but also by focusing the majority of transplantation on moderate Model for End-Stage Liver Disease (MELD) recipients while continuing to provide younger donor livers for the fewer number of patients transplanted at high MELD.
