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Title
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Outcome of liver transplant patients with high urgent priority : are we doing the right thing?
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Author
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Abstract
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| Background About 15% of liver transplantations in Eurotransplant are currently performed in patients with a high-urgency (HU) status. Patients that have acute liver failure or require an acute retransplantation can apply for this status. This study aims to evaluate the efficacy of this prioritization. Methods Patients that were listed for liver transplantation with HU status from 01.01.2007 up to 31.12.2015 were included. Waiting list and posttransplantation outcomes were evaluated and compared with a reference group of patients with labMELD scores ≥40 (MELD 40+). Results In the study period, 2,299 HU patients were listed for liver transplantation. At 10 days after listing, 72% of all HU patients were transplanted and 14% of patients deceased. Patients with HU status for primary acute liver failure showed better patient survival at 3 years (69%) as compared to patients in the MELD 40+ group (57%). HU patients with labMELD≥45 and patients with HU status for acute retransplantation and LabMELD≥35 have significantly inferior survival at 3-year follow-up of 46% and 42%, respectively. Conclusions Current prioritization for patients with acute liver failure is highly effective in preventing mortality on the waiting list. Although patients with HU status for acute liver failure have good outcomes, survival is significantly inferior for patients with a high MELD score or for retransplantations. With the current scarcity of livers in mind, we should discuss whether potential recipients for a second or even third retransplantation should still receive absolute priority, with HU-status, over other recipients with an expected, substantially better prognosis after transplantation. |
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Language
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English
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Source (journal)
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Transplantation. - Baltimore, Md, 1963, currens
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Publication
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Baltimore, Md
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2019
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ISSN
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0041-1337
1534-6080
[online]
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DOI
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10.1097/TP.0000000000002526
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Volume/pages
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103
:6
(2019)
, p. 1181-1190
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ISI
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000480682800028
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Pubmed ID
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30489481
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Full text (Publisher's DOI)
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Full text (open access)
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Full text (publisher's version - intranet only)
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