TY - JOUR
T1 - Trajectories of patients relisted for liver transplantation
AU - Qazi Arisar, Fakhar Ali
AU - Varghese, Rhea
AU - Chen, Shiyi
AU - Xu, Wei
AU - Selzner, Markus
AU - McGilvray, Ian
AU - Sayed, Blayne
AU - Reichman, Trevor
AU - Shwaartz, Chaya
AU - Cattral, Mark
AU - Ghanekar, Anand
AU - Sapisochin, Gonzalo
AU - Jaeckel, Elmar
AU - Tsien, Cynthia
AU - Selzner, Nazia
AU - Lilly, Leslie
AU - Bhat, Mamatha
N1 - Publisher Copyright:
© 2023 Fundación Clínica Médica Sur, A.C.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Introduction and Objectives: Recurrent cirrhosis complicates 10-30% of Liver transplants (LT) and can lead to consideration for re-transplantation. We evaluated the trajectories of relisted versus primary listed patients on the waitlist using a competing risk framework. Materials and Methods: We retrospectively examined 1,912 patients listed for LT at our centre between from 2012 to 2020. Cox proportional hazard models were used to assess overall survival (OS) by listing type and competing risk analysis Fine-Gray models were used to assess cumulative incidence of transplant by listing type. Results: 1,731 patients were included (104 relisted). 44.2% of relisted patients received exception points vs. 19.8% of primary listed patients (p<0.001). Patients relisted without exceptions, representing those with graft cirrhosis, had the worst OS (HR: 4.17, 95%CI 2.63 – 6.67, p=<0.0001) and lowest instantaneous rate of transplant (HR: 0.56, 95%CI 0.38 – 0.83, p=0.006) than primary listed with exception points. On multivariate analysis listing type, height, bilirubin and INR were associated with cumulative incidence of transplant, while listing type, bilirubin, INR, sodium, creatinine were associated with OS. Within relisted patients, there was a trend towards higher mortality (HR: 1.79, 95%CI 0.91 – 3.52, p=0.08) and low transplant incidence (HR: 0.51, 95%CI 0.22 – 1.15, p=0.07) for graft cirrhosis vs other relisting indications. Conclusions: Patients relisted for LT are carefully curated and comprise a minority of the waitlist population. Despite their younger age, they have worse liver/kidney function, poor waitlist survival, and decreased transplant incidence suggesting the need for early relisting, while considering standardized exception points.
AB - Introduction and Objectives: Recurrent cirrhosis complicates 10-30% of Liver transplants (LT) and can lead to consideration for re-transplantation. We evaluated the trajectories of relisted versus primary listed patients on the waitlist using a competing risk framework. Materials and Methods: We retrospectively examined 1,912 patients listed for LT at our centre between from 2012 to 2020. Cox proportional hazard models were used to assess overall survival (OS) by listing type and competing risk analysis Fine-Gray models were used to assess cumulative incidence of transplant by listing type. Results: 1,731 patients were included (104 relisted). 44.2% of relisted patients received exception points vs. 19.8% of primary listed patients (p<0.001). Patients relisted without exceptions, representing those with graft cirrhosis, had the worst OS (HR: 4.17, 95%CI 2.63 – 6.67, p=<0.0001) and lowest instantaneous rate of transplant (HR: 0.56, 95%CI 0.38 – 0.83, p=0.006) than primary listed with exception points. On multivariate analysis listing type, height, bilirubin and INR were associated with cumulative incidence of transplant, while listing type, bilirubin, INR, sodium, creatinine were associated with OS. Within relisted patients, there was a trend towards higher mortality (HR: 1.79, 95%CI 0.91 – 3.52, p=0.08) and low transplant incidence (HR: 0.51, 95%CI 0.22 – 1.15, p=0.07) for graft cirrhosis vs other relisting indications. Conclusions: Patients relisted for LT are carefully curated and comprise a minority of the waitlist population. Despite their younger age, they have worse liver/kidney function, poor waitlist survival, and decreased transplant incidence suggesting the need for early relisting, while considering standardized exception points.
KW - Donor allocation
KW - Exception points
KW - Graft cirrhosis
KW - Graft failure
KW - Re-transplant
KW - Waitlist outcomes
UR - http://www.scopus.com/inward/record.url?scp=85176415579&partnerID=8YFLogxK
U2 - 10.1016/j.aohep.2023.101168
DO - 10.1016/j.aohep.2023.101168
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C2 - 37858675
AN - SCOPUS:85176415579
SN - 1665-2681
VL - 29
JO - Annals of Hepatology
JF - Annals of Hepatology
IS - 1
M1 - 101168
ER -