Who Fares Worse After Liver Transplantation? Impact of Donor and Recipient Variables on Outcome: Data from a Prospective Study Martina Gambato, 1 Anna C. Frigo, 2 Kryssia I. Rodrı ´guez Castro, 1 Marco Senzolo, 1 Elena Nadal, 1 Francesco D’Amico, 3 Alessandro Vitale, 3 Enrico Gringeri, 3 Giacomo Zanus, 3 Umberto Cillo, 3 Francesco P. Russo, 1 and Patrizia Burra 1,4 Background. Numerous donor and recipient risk factors influence survival after liver transplantation (LT). Methods. The aim of this study was to prospectively evaluate the effect of donor and recipient variables on 12-month patient and graft survival after LT. Five hundred forty-six patients underwent LTin a single center (2000Y2010). Results. Bilirubin (P=0.006) and cold ischemia time (P =0.002) were predictive of graft loss at 12 months after LT. Model for End-Stage Liver Disease score Q25 was associated with a lower 12-month graft survival than Model for End-Stage Liver Disease score G15 (P =0.02). Hepatitis C virus (HCV)Ypositive patients showed a lower survival than HCV-negative patients 12 months after LT (P =0.04), with serum sodium concentration (P =0.01) predictive for graft survival. Donor age demonstrated a trend of prediction (P=0.05) for HCV-positive patient survival. In hepatocellular carcinoma patients, donor age (P =0.02 and 0.02) and use of partial graft (P =0.01 and 0.02) were predictive of patient and graft survival at 12 months after LT. Conclusions. Bilirubin and cold ischemia time are crucial for graft outcome post-LT. Survival in HCV-positive patients is lower than in HCV-negative recipients. Donor age and partial graft use are predictive of patient and graft survival in hepatocellular carcinoma patients. Keywords: Liver transplantation, Donor criteria, Recipient features. (Transplantation 2013;95: 1528Y1534) I n recent years, the concept of patient-specific need in liver transplantation (LT) has gained preponderance, and sev- eral models have been proposed to achieve the best possible donorYrecipient match to obtain better patient and graft sur- vival and transplant benefit (1). After 2002, the introduction of Model for End-Stage Liver Disease (MELD) score to prioritize patients awaiting LT led to a reduction in LTwaiting list mor- tality without affecting posttransplant mortality, and follow- ing United States, other countries started to use the same score. Although MELD score is a predictor of mortality on the waiting list, its ability to predict posttransplant survival is much weaker (2). Attempts have been made at improving the MELD score, including adding serum sodium into the equation (3); this variable, however, seemingly does not have an impact on survival in this setting (4), but this needs to be further confirmed. The second point is to define which grafts are accept- able for transplantation, because expanded criteria organs also often confer recipients an increased risk, both in terms of graft failure and recipient mortality, which partly depend on the quality of the donor graft. Feng et al. (5) in 2006 identified seven donor characteristics that independently predict a significantly increased risk of graft failure and de- veloped a quantitative donor risk index to guide the surgeons on organ allocation. To improve the accuracy of MELD in predicting post- transplant survival, donor age was included, obtaining the D-MELD score, which has been proven to effectively strat- ify posttransplant patient survival (6). This score was used in a CLINICAL AND TRANSLATIONAL RESEARCH 1528 www.transplantjournal.com Transplantation & Volume 95, Number 12, June 27, 2013 The authors declare no funding or conflicts of interest. 1 Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy. 2 Department of Environmental Medicine and Public Health, Padua Uni- versity, Padua, Italy. 3 Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Oncology and Gastroenterology, Padua University Hospital, Padua, Italy. 4 Address correspondence to: Patrizia Burra, Multivisceral Transplant Unit, Department of Surgery, Oncology and Gastroenterology, Padua Uni- versity Hospital, Via Giustiniani 2, 35128 Padua, Italy. E-mail: burra@unipd.it M.G. collected the data and participated in the research design, data analysis, writing of the article, and performance of study. A.C.F. participated in the data analysis. K.I.R.C. participated in the writing of the article. M.S., U.C., and F.P.R. participated in the research design. E.N., F.D.A., A.V., E.G., and G.Z. participated in the data collection. P.B. participated in the performance of study. Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com). Received 27 November 2012. Revision requested 20 December 2013. Accepted 15 March 2013. Copyright * 2013 by Lippincott Williams & Wilkins ISSN: 0041-1337/13/9512-1528 DOI: 10.1097/TP.0b013e318292827f Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.