Impact of the new MELD‐based allocation system on waiting list and post‐transplant survival—a cohort analysis using the French national CRISTAL CRISTAL database

摘要

Summary Concerns related to equity and efficacy of our previous center‐based allocation system have led us to introduce a patient‐based allocation system called the “Liver Score” that incorporates the model for end‐stage liver disease ( MELD ) score. The main objective of this study was to compare waitlist and post‐transplant survivals before and after implementation of the “Liver Score” using the French transplant registry (period before: 2004–2006 and period after: 2007–2012). Patients transplanted during the second period were sicker and had a higher MELD . One‐year waitlist survival (74% vs. 76%; P ?=?0.8) and 1‐year post‐transplant survival (86.3% vs. 85.7%; P ?=?0.5) were similar between the 2 periods. Cirrhotic recipients with MELD 35 had lower 1‐year post‐transplant survival compared to those with MELD 35 (74.8% vs. 86.3%; P ??0.01), mainly explained by their higher intubation and renal failure rates. The MELD showed a poor discriminative capacity. In cirrhotic recipients with MELD 35, patients presenting 2 or 3 risk factors (dialysis, intubation, or infection) had a lower 1‐year survival compared to those with none of these risk factors (61.2% vs. 92%; P ??0.01). The implementation of the MELD ‐based allocation system has led to transplant sicker patients with no impact on waitlist and post‐transplant survivals. Nevertheless, selection of patients with MELD 35 should be completed to allow safe transplantation.