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Waitlist mortality and post-transplant survival in patients with cholestatic liver disease - Impact of changes in allocation policy.
- Source :
-
HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2018 Oct; Vol. 20 (10), pp. 916-924. Date of Electronic Publication: 2018 Jun 21. - Publication Year :
- 2018
-
Abstract
- Background: This study investigated the impact of Model of end-stage liver disease (MELD)-score introduction (MELDi) on waitlist mortality and post-liver transplant (LT) survival in primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC).<br />Methods: LT candidates with PSC or PBC listed between January 1983 and March 2016 were included and followed until December 2016. After MELDi in 2004, PBC patients were listed according to labMELD, PSC patients according to the highest MELD during active cholangitis (chMELD).<br />Results: In total, 100 PBC and 76 PSC patients were included. Waitlist mortality in PBC was significantly higher than in PSC (16% vs. 5.3%, p = 0.031), whereas PSC patients were significantly more often withdrawn from the waitlist due to improved condition (3.0% vs. 13.2%, p = 0.017). Competing risks analysis identified MELDi (HR = 4.12) and PBC (HR = 2.95) as significant predictors of waitlist mortality. Yet, overall 10 y-patient survival increased after MELDi by 18.8% leading to a 1 y-, 5 y-, and 10 y-patient survival of 98.2%, 70.6% and 70.6% in PBC, and 83.3%, 83.3%, and 80.6% in PSC, respectively.<br />Conclusions: PSC patients showed significantly lower waitlist mortality irrespective of MELDi, whereas in PBC waitlist mortality further increased after MELDi. Utility of MELD and chMELD did not impair post LT outcome.<br /> (Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
- Subjects :
- Adult
Austria
Cholangitis, Sclerosing diagnosis
Cholangitis, Sclerosing mortality
Clinical Decision-Making
Decision Support Techniques
Female
Graft Survival
Humans
Liver Cirrhosis, Biliary diagnosis
Liver Cirrhosis, Biliary mortality
Male
Middle Aged
Postoperative Complications mortality
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Cholangitis, Sclerosing surgery
Liver Cirrhosis, Biliary surgery
Liver Transplantation adverse effects
Liver Transplantation mortality
Policy Making
Tissue and Organ Procurement organization & administration
Waiting Lists mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1477-2574
- Volume :
- 20
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- HPB : the official journal of the International Hepato Pancreato Biliary Association
- Publication Type :
- Academic Journal
- Accession number :
- 29937419
- Full Text :
- https://doi.org/10.1016/j.hpb.2018.03.013