T. A. Russell1, D. Graham1, V. Agopian2, J. DiNorcia2, D. Markovic3, S. Younan2, D. Farmer2, H. Yersiz2, R. Busuttil2, F. Kaldas2 1University Of California – Los Angeles,General Surgery,Los Angeles, CA, USA 2University Of California – Los Angeles,Liver & Pancreas Transplantation,Los Angeles, CA, USA 3University Of California – Los Angeles,Biomathematics,Los Angeles, CA, USA
Introduction: Annually less than 60% of waitlisted patients receive liver transplantation (LT), resulting in over 2,000 waitlist deaths. Historically, the minimum threshold for survival benefit (SB) with LT is a model for end-stage liver disease (MELD) score of 15. Limited organ availability and geographic disparities require examination of the relative LT-SB in the post MELD era to ensure optimization of lives saved.
Methods: All waitlisted adults from 2/2002-3/2017 (excluding Status-1A, MELD-exception candidates) within in the United Network for Organ Sharing (UNOS) database were included. Patients were followed from the time of listing to 3-months post-transplant or waitlist-removal. Survival-time was accrued to MELD categories according to score changes over time. LT-SB hazard ratios were computed comparing waitlist to post-LT survival for the entire cohort and by UNOS regions and by eras (2002-2006, 2007-2011, 2012-2017). The threshold for SB was defined by a HR <1.0, indicating SB for receiving LT as compared to remaining on waitlist.
Results: 107,503 patients were waitlisted; 46,249 underwent LT. By era, the 3-month LT-SB threshold was at MELD 19, 20-23, and 20-23 (Figure 1). All UNOS regions had a common 3-month LT-SB threshold of MELD 21-29 for the entire study period. At time of LT 10,899 (24%) patients had a MELD of 15-20, while 3,756 (8.1%) had a MELD<15. Fifty percent (n=1891) of LT for MELD <15 were done in 3 of the 11 UNOS regions.
Conclusion: The 3-month SB-LT threshold of MELD >20 suggests an increase from the previously established score of 15, yet patients continue to undergo LT at MELDs even below 15 in donor rich regions. These findings highlight the potential to save more lives by allocating organs to higher acuity patients at increased risk of 3-month pre-transplant mortality.
