Disease‐specific waitlist outcomes in liver transplantation – a retrospective study

Abstract

Summary This study aimed to evaluate possible discrepancies in waitlist outcomes between liver diseases, including alcohol‐related liver disease (ALD), nonalcoholic steatohepatitis (NASH), hepatitis C virus infection (HCV), primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC). Patients registered for liver transplantation from January 11, 2016, to June 30, 2018, were evaluated using OPTN/UNOS registry. Waitlist outcomes were compared between the five‐disease groups. Patients were categorized by initial MELD‐Na‐score (6–20, 21–29, and ≥30) to identify outcome variations. Prognostic impact of transplantation was assessed according to final MELD‐Na scores using Cox regression analysis modeling transplantation as a time‐dependent covariate. 6053 with ALD, 3814 with NASH, 1558 with HCV, 602 with PBC, and 819 with PSC were eligible. Compared to ALD with comparable MELD‐Na‐scores, NASH with lower [adjusted hazard ratio (aHR) = 1.30, P = 0.042] and mid‐scores (aHR = 1.35, P = 0.008) showed significantly higher risk of 1‐year waitlist mortality, and PBC with higher scores showed significantly higher risk of 90‐day (aHR = 1.69, P = 0.03) and 1‐year waitlist mortality (aHR = 1.69, P = 0.02). Positive prognostic impact of transplantation was not seen until score of 24–27 in ALD, 18–20 in HCV, 15–17 in NASH, and 24–27 in PBC and PSC. There are significant differences in waitlist outcomes among etiologies, which may differ the optimal transplant timing.

Use of neural network models to predict liver transplantation waitlist mortality

“…It was reported that disease progression and LT waitlist outcomes might differ between the primary etiologies. [ 21 ] The NN models was created by including primary liver disease etiologies which showed excellent AUC‐ROC and AUC‐PR in the major disease etiology groups (Table S5). Because the NN model considers patients' primary liver disease, allocation system using NN can consider the difference in disease progression according to the liver disease etiologies and provide more accurate prediction of mortality according to the liver diseases.…”

Liver transplantation for non-alcoholic fatty liver disease: indications and post-transplant management

“…A recent analysis on patients from OPTN/UNOS registry showed that, in comparison to patients with alcoholic liver disease, the risk of 90-day and 1-year waitlist mortality was significantly higher in NASH patients (p=0.042 and p=0.008) (45). MELD-Na score, CKD stage >3 and hyponatremia were significantly associated to mortality.…”

“…A recent analysis on patients from OPTN (Organ Procurement and Transplantation Network)/UNOS (United Network for Organ Sharing) registry showed that, in comparison to patients with alcoholic liver disease (ALD), the risk of 90-day and 1-year waitlist mortality was significantly higher in NASH patients ( P =0.042 and P =0.008) [ 45 ]. Model for End-Stage Liver Disease-Na (MELD-Na) score, Chronic Kidney Disease (CKD) stage >3 and hyponatremia were significantly associated to mortality.…”

“…Nagai and colleagues also demonstrated that 90- day Delta MELD-Na was lower in Alcoholic Liver Disease (ALD) patients than in NASH patients, suggesting that NASH patients may have a faster disease progression. When considering patients with HCC as indication to LT, NASH patients showed a higher risk of 1-year waitlist mortality compared to HCC-ALD; however, an explanation could be that NASH patient were older [ 45 ]. Another study based on UNOS registry data from 2002 to 2016 found a higher unadjusted cumulative incidence of exclusion from wait list (WL) for mortality and deterioration in NAFLD patients compared to patients with other indications to LT, but when adjusted for confounder factors, waitlist mortality was similar between NASH and non-NASH patients [ 46 ].…”

With Alcohol as the Fuel, COVID Is the Match

“…In addition, the prognostic utility of the MELD‐Na score is increasingly recognized as being less reliable in ALD patients with high MELD scores that actually have a mortality rate comparable to non‐ALD patients with lower MELD scores. ( 11 ) With that in mind, several groups have suggested that a minimum duration of abstinence for patients with ALD and particularly concomitant acute kidney injury may be reasonable to facilitate hepatic recovery and avoid unnecessary transplants. However, this does not imply that patients with ALD are less deserving of LT.…”