Increasing liver transplantation waiting list mortality: a report from the Australian National Liver Transplantation Unit, Sydney

Prakoso, Emilia; Verran, Deborah; Dilworth, Pamela; Kyd, G.; Tang, Patrick; Tse, Cindy Wing-Sze; Koorey, David; Strasser, Simone I.; Stormon, Michael; Shun, Albert; Thomas, Gordon; Joseph, David; Pleass, Henry; Gallagher, James; Allen, Richard D.; Crawford, Michael; McCaughan, Geoffrey W.; Shackel, Nicholas

doi:10.1111/j.1445-5994.2010.02277.x

Cited by 13 publications

(10 citation statements)

References 35 publications

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“…The mean waiting time for DDLT was 35.81±29.18 days, which was substantially shorter than previous reports [21], [22]. In mainland China, health insurance does not cover liver transplantation [23], [24].…”

Section: Discussionmentioning

confidence: 81%

Outcomes of Patients with Benign Liver Diseases Undergoing Living Donor versus Deceased Donor Liver Transplantation

Wen

et al. 2011

PLoS ONE

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Background/AimsThe number of people undergoing living donor liver transplantation (LDLT) has increased rapidly in many transplant centres. Patients considering LDLT need to know whether LDLT is riskier than deceased donor liver transplantation (DDLT). The aim of this study was to compare the outcomes of patients undergoing LDLT versus DDLT.MethodsA total of 349 patients with benign liver diseases were recruited from 2005 to 2011 for this study. LDLT was performed in 128 patients, and DDLT was performed in 221 patients. Pre- and intra-operative variables for the two groups were compared. Statistically analysed post-operative outcomes include the postoperative incidence of complication, biliary and vascular complication, hepatitis B virus (HBV) recurrence, long-term survival rate and outcomes of emergency transplantation.ResultsThe waiting times were 22.10±15.31 days for the patients undergoing LDLT versus 35.81±29.18 days for the patients undergoing DDLT. The cold ischemia time (CIT) was 119.34±19.75 minutes for the LDLT group and 346±154.18 for DDLT group. LDLT group had higher intraoperative blood loss, but red blood cell (RBC) transfusion was not different. Similar ≥ Clavien III complications, vascular complications, hepatitis B virus (HBV) recurrence and long-term survival rates were noted. LDLT patients suffered a higher incidence of biliary complications in the early postoperative days. However, during the long-term follow-up period, biliary complication rates were similar between the two groups. The long-term survival rate of patients undergoing emergency transplantation was lower than of patients undergoing elective transplantation. However, no significant difference was observed between emergency LDLT and emergency DDLT.ConclusionsPatients undergoing LDLT achieved similar outcomes to patients undergoing DDLT. Although LDLT patients may suffer a higher incidence of early biliary complications, the total biliary complication rate was similar during the long-term follow-up period.

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Section: Discussionmentioning

confidence: 81%

Outcomes of Patients with Benign Liver Diseases Undergoing Living Donor versus Deceased Donor Liver Transplantation

Wen

et al. 2011

PLoS ONE

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“…[1][2][3] The median pretransplantation waiting time among active wait-listed adult patients increased from 12.9 months in 2009, to 17.6 months in 2010, to 18.5 months in 2011. 2 In an effort to expand available organs for liver transplantation, many transplant centers are looking beyond the traditional "ideal" donor, to include the use of marginal or extended criteria donor organs, including the use of grafts from older donors.…”

mentioning

confidence: 98%

Donor Age-Based Analysis of Liver Transplantation Outcomes: Short- and Long-Term Outcomes Are Similar Regardless of Donor Age

Chapman¹,

Vachharajani²,

Collins³

et al. 2015

Journal of the American College of Surgeons

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“…Age was a significant predictive factor only after the implementation of MELD scoring. Age has previously been described as an independent risk factor for mortality in patients with cirrhosis in several studies 29‐32. Most authors have reported a higher risk for patients more than 50 years old 33‐36.…”

Section: Discussionmentioning

confidence: 97%

Risk factors for long-term mortality in a large cohort of patients wait-listed for liver transplantation in Brazil

et al. 2011

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Liver donor shortage and long waiting times are observed in many liver transplant programs worldwide. The aim of this study was to evaluate the wait list in a developing country, before and after the introduction of the MELD scoring system. In addition, the MELD score ability to predict mortality in this setting was assessed. A single-center retrospective study of patients wait-listed for liver transplantation between 1997 and 2010 was undertaken. There were 1339 and 762 patients on the list in pre-MELD and MELD era, respectively. A competitive risk analysis was performed to assess age, gender, disease diagnosis, serum sodium, MELD, Child-Pugh, ABO type, and body mass index. Also, MELD score predictive ability at 3, 6, 12, and 24 months after list enrollment was evaluated. The overall mortality rates on waiting list were 31.0% and 28.1% (P ¼ 0.16), and the median waiting times were 412 and 952 days (P < 0.001), in pre and MELD eras, respectively. The competitive risk analysis yielded the following significant P values for both eras: HCC (0.03 and <0.001), MELD (<0.001 and 0.002), sodium level (0.002 and <0.001), and Child-Pugh (0.02 and <0.001). The MELD mortality predictions at 3, 6, 12, and 24 months were similar. In conclusion, in a liver transplant program with long waiting times, the MELD system introduction did not improve mortality rate. In either pre and MELD eras, HCC diagnosis, serum sodium, Child-Pugh, and MELD were significant predictors of prognosis. Short-and long-term MELD based mortality predictions were similarly accurate. Strategies for increasing the liver donor pool should be implemented to improve mortality.

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Increasing liver transplantation waiting list mortality: a report from the Australian National Liver Transplantation Unit, Sydney

Abstract: Despite the increasing proportion of donor offers being used, the waiting list mortality is increasing. A solution to this problem is an increase in organ donation to keep pace with the escalating demand for LTx.

Cited by 13 publications

References 35 publications

Outcomes of Patients with Benign Liver Diseases Undergoing Living Donor versus Deceased Donor Liver Transplantation

Outcomes of Patients with Benign Liver Diseases Undergoing Living Donor versus Deceased Donor Liver Transplantation

Donor Age-Based Analysis of Liver Transplantation Outcomes: Short- and Long-Term Outcomes Are Similar Regardless of Donor Age

Risk factors for long-term mortality in a large cohort of patients wait-listed for liver transplantation in Brazil

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