The Survival Benefit of Liver Transplantation

Abstract

Demand for liver transplantation continues to exceed donor organ supply. Comparing recipient survival to that of comparable candidates without a transplant can improve understanding of transplant survival benefit. Waiting list and post-transplant mortality was studied among a cohort of 12 996 adult patients placed on the waiting list between 2001 and 2003. Timedependent Cox regression models were fitted to determine relative mortality rates for candidates and recipients. Overall, deceased donor transplant recipients had a 79% lower mortality risk than candidates (HR = 0.21; p < 0.001). At Model for End-stage Liver Disease (MELD) 18-20, mortality risk was 38% lower (p < 0.01) among recipients compared to candidates. Survival benefit increased with increasing MELD score; at the maximum score of 40, recipient mortality risk was 96% lower than that for candidates (p < 0.001). In contrast, at lower MELD scores, recipient mortality risk during the first post-transplant year was much higher than for candidates (HR = 3.64 at MELD 6-11, HR = 2.35 at MELD 12-14; both p < 0.001). Liver transplant survival benefit at 1 year is concentrated among patients at higher risk of pre-transplant death. Futile transplants among severely ill patients are not identified under current practice. With 1 year post-transplant follow-up, patients at lower risk of pre-transplant death do not have a demonstrable survival benefit from liver transplant.

Model for End-stage Liver Disease

“…60 However, this may not be true for living donor liver transplantation for non-HCC patients as they still derived a significant survival benefit compared to patients waiting for deceased donor due to reduced wait time and better graft quality. 61 This was confirmed in a study analyzing the UNOS database where transplant benefit of patients with MELD <16 depended upon the quality of graft they received, and poor survival benefit amongst these patients was due to receipt of grafts with the highest donor risk index.…”

Platelet Transfusion Improves Liver Function in Patients with Chronic Liver Disease and Cirrhosis

“…In addition to thrombocytopenia, patients with CLD and cirrhosis experience serious complications, such as ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, portal hypertension, esophagogastric variceal hemorrhage, and hepatorenal syndrome (D'Amico et al 2006;Heidelbaugh and Sherbondy 2006). When medications or procedural treatments fail to control various symptoms related to CLD and cirrhosis, the only effective therapy is liver transplantation (Merion et al 2005). However, liver transplantation is associated with serious problems, such as donor shortage, surgical complications, organ rejection, and high cost (Neuberger and James 1999;Taylor et al 2002;Mueller et al 2004;Porrett et al 2009).…”

The Lille model: A new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids

“…The advantage of accurate models has been confirmed by the growing importance of the MELD score in the selection of candidates for liver transplantation. [7][8][9] In patients with DF Ն 32, several RCTs and a recent meta-analysis showed that corticosteroids improve shortterm survival. 1,5,[10][11][12][13][14] However, novel strategies or molecules are required, in light of the fact that approximately 40% of patients die at 6 months.…”