Roman Liver Tx Allocation: Results at 48 months of an innovative regional allocationmodel based on MELDNa and Donor-to-Recipient Match

Roman Liver Tx Allocation: Results at 48 months of an innovative regional allocation model based on MELDNa and Donor-to-Recipient Match Federica Ferracci1, Alfonso W. Avolio1, Francesca R. Ponziani1, Antonio Grieco1, Salvatore Agnes1, Stefano Ginanni Corradini2, Fabio Melandro2, Flaminia Ferri2, Massimo Rossi2, Tommaso M. Manzia3, Ilaria Lenci3, Matteo Manuelli3, Mario Angelico3, Giuseppe Tisone3, Giovanni Vennarecci4, Marco Colasanti4, Roberto L. Meniconi4, Ubaldo Visco Comandini4, Giuseppe M. Ettorre4, Raffaella Zaccaria5, Nicola Torlone5, Maurizio Valeri5; 1Transplant center - University Hospital “A. Gemelli”, Rome, Italy; 2Transplant center - University Hospital “Umberto I”, Rome, Italy; 3Transplant center - University Hospital “Tor Vergata”, Rome, Italy; 4Transplant center - San Camillo Hospital, Rome, Italy; 5Transplant center - Regione Lazio, Rome, Italy BACKGROUND Liver allocation policies are different between Countries and regions. An innovative allocation model based on MELDNa and donor age was developed in Italy in a donor-to-recipient match perspective. 244 Liver transplants (LT) performed (2013-2015) in a 4 Center regional Consortium were compared to 235 controls (2010- 2012). P&M In the 2013-2015 period, Standard Organs (SO, N=151, 61,8%) were allocated to patients (pts) on a common regional waiting list, based on MELDNa (5 classes: >30, N=32, 13.2%; 29-24, N=41, 16.8%; 23-20, N=19, 7.8%; 19-15, N=24, 9.8%; <15, N=35, 14.3%). Non-SO (donor age >65, N=76, 31.2%;other reasons, N=17, 6.9%) were allocated locally, according to priority defined in each Center. and to individual patient’s characteristics (mainly HCC pts with progressive disease). In the 2010-2012 period each Center used a MELD based allocation algorithm and HCC pts were equipoised to non-HCC pts using the MELD 22 rule. Univariate Kaplan Meier (KM) and multivariate Cox analyses (Cox) were used. RESULTS LT in 2013-2015 period were older, with higher MELDNa, and received organs by older donors. Regarding non-HCC patients: Recipient’s age: 52±11 vs 50±11; Donor’s age: 51±18 vs 52±18; MELD at LT: 23±7 vs 21±7, p=0.002; MELDNa at LT: 25±7 vs 22±7, p=0.003. Regarding HCC patients: Recipient’s age: 58±6 vs 57±8; Donor’s age: 56±17 vs 52±18; MELD at LT: 15±6 vs 14±6; MELDNa at LT: 16±7 vs 15±5. Waiting time was significantly lower for non-HCC group 2.0±4.4 vs 6.7±8.3 mo, p=0.0001, and unchanged for the HCC patients 5.7±5.2 vs 5.3±5. 48 mo patient survival was similar (KM: overall 76% continuos l vs 79% dotted l; non-HCC: 78% vs 80%; HCC: 73% vs 77%). MELDNa and recipient’s age resulted significant prognostic predictors at Cox. CONCLUSIONS Although overall survival was slightly reduced in the non-SO HCC subgroup, the innovative allocation model provides positive results about overall LT performed, using organs from older donors, and faster transplantation for pts with progressive liver disease.