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End-stage liver disease patients with MELD >40 have higher waitlist mortality compared to Status 1A patients

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Abstract

Background and aims

Status 1A patients are prioritized over end-stage liver disease (ESLD) for liver transplantation (LT). ESLD patients with high MELD may have higher waitlist mortality than Status 1A patients, and may require LT more urgently.

Methods

Using United Network for Organ Sharing registry data, we retrospectively evaluated LT waitlist mortality and probability of LT between adults in the United States with Status 1A or ESLD with MELD >30 listed for LT from 2003–2013. Overall waitlist mortality and probability of LT were evaluated with Kaplan–Meier and multivariate logistic regression models.

Results

From 2003–2013, 15,049 ESLD patients with MELD >30 and 3049 Status 1A patients were listed for LT. While overall 14-day waitlist survival decreased with increasing MELD score among ESLD patients (54.0 % for MELD 31–35; 37.1 % for MELD 36–40; 27.5 % for MELD >40), overall survival at 14 days was significantly lower among Status 1A (14.4 %). Compared to Status 1A, ESLD patients with MELD >40 had significantly higher 14-day waitlist mortality (OR 1.92; 95 % CI 1.56–2.36; p < 0.001), whereas ESLD patients with MELD 36–40 had a non-significant trend towards higher waitlist mortality (OR 1.16; 95 % CI 0.93–1.45; p = 0.181). No difference in probability of LT within 14 days was observed between ESLD with MELD >40 and Status 1A (p = 0.89). ESLD patients with MELD >40 had higher post-LT survival compared to Status 1A on multivariate regression modeling (HR 0.80; 95 % CI 0.66–0.96; p < 0.02).

Conclusion

Among adults in the United States awaiting LT, ESLD patients with MELD >40 have significantly higher waitlist mortality, but similar probability of receiving LT compared to Status 1A patients.

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Abbreviations

CI:

Confidence interval

ESLD:

End stage liver disease

FHF:

Fulminant hepatic failure

HR:

Hazards ratio

INR:

International normalized ratio

LT:

Liver transplantation

MELD:

Model for end-stage liver disease

OPTN:

Organ procurement and transplantation network

OR:

Odds ratio

SHR:

Sub-hazard ratio

SRTR:

Scientific registry of transplant recipients

UNOS:

Unified Network for Organ Sharing

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Authors and Affiliations

  1. School of Medicine, University of California, San Francisco, CA, USA

    Joseph Ahn

  2. Endoscopy Unit, Division of Gastroenterology and Hepatology, Alameda Health System-Highland Hospital, 1411 East 31st Street, Highland Hospital-Highland Care Pavilion 5th Floor, Oakland, CA, 94602, USA

    Taft Bhuket, Sasan Mosadeghi, Benny Liu & Robert J. Wong

  3. Department of Organ Transplantation, Scripps Green Hospital, San Diego, CA, USA

    Catherine Frenette

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  1. Joseph Ahn
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  2. Taft Bhuket
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  3. Sasan Mosadeghi
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Corresponding author

Correspondence to Robert J. Wong.

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Funding

No funding was provided for this study.

Conflict of interest

Joseph Ahn, Taft Bhuket, Sasan Mosadeghi, Catherine Frenette, Benny Liu, and Robert J Wong have no relevant conflicts of interest to report.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was not required given the retrospective observational study design.

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Ahn, J., Bhuket, T., Mosadeghi, S. et al. End-stage liver disease patients with MELD >40 have higher waitlist mortality compared to Status 1A patients. Hepatol Int 10, 838–846 (2016). https://doi.org/10.1007/s12072-016-9735-4

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  • DOI: https://doi.org/10.1007/s12072-016-9735-4

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