[Predictors of mortality among liver transplant candidates].

Reports in the literature make a distinction between death on the waiting list for liver transplantation and mortality after transplant. Predicting survival at Listing with or without a transplant may assist in evaluating the option of living-donor liver transplantation. The model for end-stage liver disease, or MELD score was found to be a reliable predictor of 3-months mortality on the waiting list. However, with increasing waiting time and severe organ shortage, as is the case in Israel, the consistency of the MELD score in predicting mortality of liver transplant candidates is questionable. The authors sought to determine predicted survival in candidates for liver transplantation in Israel and define risk factors for mortality based on parameters available at the time of registration for transplant. A survival analysis was performed including 197 candidates with chronic liver disease listed for transplant between the years 2001-2006 at the Rabin Medical Center. In addition, the authors used multivariate analysis to define risk factors for mortality based on demographic, clinical and laboratory parameters available at registration. With a median follow-up of 50.7 months from registration of the 197 patients included in our study, 123 underwent transplant, while 74 patients were not transplanted. The median waiting time for transplant was 316 days. Overall, 85 (43%) patients died, including 57 before and 28 after transplant (p < 0.0001). Survival rates for the whole group were 67% and 54.6% for 1- and 5-years, respectively. In a multivariate analysis MELD score, recipient age, albumin level and the presence of hepatorenal syndrome were found as significant risk factors for mortality among registrants for liver transplantation. In Israel, with waiting time averaging nearly one year, about a third of the candidates will die before transplant and 54% will survive 5 years with and without a transplant. This information should indicate a wider use of living related liver transplantation. The MELD score is a significant predictor of mortality on the waiting list, even with the waiting time far exceeding the 3 months interval from listing, although this finding should be further verified in Larger studies.