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Liver Allocation in Urgent MELD Score ≥30: The Italian Experience
S Trapani1, V Morabito1, A Oliveti1
1Italian National Transplant Center, Rome, Italy.
Introduction:
Patients with an urgent MELD score ≥30 are managed by the Italian Operative National Transplant Center on the basis of a division of Italy into 2 main areas, the northern macro area (NMA) and the southern macro area (SMA). The object of this study was to evaluate the possibility and the need to transform the MELD score ≥30 macro area-based program into a nationwide one.
Patients And Methods:
When a region reports the presence of a patient with a MELD score ≥30, the same macro area-compatible donors, in the absence of urgent national and 1B status, are offered primarily to this recipient.
Results:
From August 2014 to August 2015, 132 requests for patients with urgent MELD score ≥30, 98 from the NMA and 34 from the SMA, were handled. The average waiting list in the NMA was significantly different from that of the SMA (2.74 ± 2.29 vs 4.5 ± 3.98, P < .05). A total of 73.7% of the received requests (n = 97) were satisfied: the NMA met 80.4% of the requests (n = 77), whereas the SMA met 55.5% (n = 20). A total of 35 requests (26.5%), 21 from the NMA (60%) and 14 (40%) from the SMA, were not met. The average waiting time of these recipients for a liver was significantly different between the NMA and the SMA (3.14 ± 3.21 vs 5.78 ± 4.59; P < .05).
Conclusions:
The MELD score is a priority allocation, and the longer the waiting time to transplantation for these recipients, the more their mortality increases. Given the differences in waiting times between the NMA and SMA, we should start thinking about transforming the macro area program into a national one.
Insights
Urgent liver transplant candidates with a MELD score ≥30 face longer waits in Italy’s Southern Macro Area (SMA) compared to the Northern Macro Area (NMA). This study suggests a nationwide program is needed to improve transplant access for these critical patients.
Area of Science:
- Transplant Medicine
- Organ Allocation Systems
- Hepatology
Background:
- Patients with an urgent MELD score ≥30 in Italy are managed by a macro area-based system (Northern Macro Area - NMA, Southern Macro Area - SMA).
- This system divides Italy into two main regions for managing liver transplant recipients with critical scores.
Purpose of the Study:
- To evaluate the feasibility and necessity of transitioning the MELD score ≥30 macro area-based program to a nationwide system.
- To analyze disparities in liver transplant access for patients with urgent MELD scores between Italy's NMA and SMA.
Main Methods:
- Retrospective analysis of urgent MELD score ≥30 liver transplant requests from August 2014 to August 2015.
- Comparison of waiting list times, request fulfillment rates, and unmet requests between the NMA and SMA.
Main Results:
- A total of 132 requests were handled; 98 from NMA and 34 from SMA.
- The NMA had significantly shorter average waiting list times (2.74 ± 2.29 days) compared to the SMA (4.5 ± 3.98 days).
- Transplant fulfillment rates were higher in the NMA (80.4%) than in the SMA (55.5%), with significantly longer waiting times for unmet requests in the SMA (5.78 ± 4.59 days).
Conclusions:
- Significant disparities exist in liver transplant waiting times and access between Italy's NMA and SMA for patients with MELD scores ≥30.
- The increased mortality risk associated with longer waiting times necessitates consideration of a nationwide transplant program.
- Transitioning to a national program could improve equity and timely access to liver transplantation for critically ill patients.
