AUTHOR=Dancs Peter T. , Saner Fuat H. , Benkö Tamas , Molmenti Ernesto P. , Büchter Matthias , Paul Andreas , Hoyer Dieter P. 

TITLE=Balancing Outcome vs. Urgency in Modern Liver Transplantation

JOURNAL=Frontiers in Surgery

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.853727

DOI=10.3389/fsurg.2022.853727

ISSN=2296-875X

ABSTRACT=Background: Current allocation mechanisms for liver transplantation 
(LT) overemphasize emergency, leading to poorer longtime outcomes. Utility was introduced to recognize outcomes in allocation. Recently, Molinari proposed a predictive outcome model based on recipient data. 
Aims: The aims of this study were to validate this model and to combine it with utility to emphasize outcome in allocation.
Methods: We retrospectively analyzed 734 patients transplanted between January 2010 and December 2019. Points were assigned as in Molinari’s model, and score sum was correlated with observed 90-day mortality. Utility was calculated as the product of 1-year survival times 3-month mortality on the waiting list. Weighting of different compounds was introduced, and utility curves were calculated. MELD scores according to maximal utility were determined.  
Results: 120 patients (16.3%) died within 90 days after LT. Higher MELD score, obesity, and hemodialysis prior to LT were confirmed risk factors. Overall survival was 83.8% and 77.4% after 90 days and 12 months, respectively. General utility culminated at MELD scores >35 in the overall population. Emphasizing outcome shifted the maximal utility to lower MELD scores, depending on Molinari scores.
Conclusions: Emphasizing outcome, at least in certain recipient risk categories, might improve the longtime outcomes and might be integrated into allocation models.