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03 May 2019 : Original article  

Risk Factors for High Mortality on the Liver Transplant Waiting List in Times of Organ Shortage: A Single-Center Analysis

Peri Husen1CDEF*, Julian Hornung1B, Tamas Benko1D, Christian Klein1D, Katharina Willuweit2D, Matthias Buechter2DE, Fuat Hakan Saner1DE, Andreas Paul1ADEF, Juergen Walter Treckmann1D, Dieter Paul Hoyer1ABCDEF

DOI: 10.12659/AOT.914246

Ann Transplant 2019; 24:242-251

Abstract

BACKGROUND: Germany has the highest rate of patients dying or becoming unfit for transplant while waitlisted within the Eurotransplant region. Therefore, the aim of the current study was to analyze mortality as well as risk factors for mortality of candidates listed for liver transplantation at our center.

MATERIAL AND METHODS: Between 01/2011 and 12/2013, 481 adult patients were listed for primary liver transplantation (LT) at a single German center. Clinical and laboratory parameters were prospectively collected and retrospectively analyzed by univariable and multivariable logistic regression and Cox proportional hazards.

RESULTS: The mean model for end-stage liver disease (MELD) score of all liver transplant waitlist registrants (52.4 years, 60.1% male) was 16.9 (±10.2) at time of listing, with 10% of the listed patients having a MELD score of >32. After waitlisting, 133 (27.7%) candidates died within the follow-up period. Three-month-survival after listing for transplantation was 89% for patients ultimately receiving LT vs. 71.2% that did not receive LT (p<0.001). Multivariable analysis identified clinical parameters such as ICU treatment, preceding abdominal surgery, variceal bleeding, and ascites, as well as hydropic decompensation, as independent risk factors for waitlist mortality.

CONCLUSIONS: Consideration of independent risk factors of mortality within the MELD-based allocation system potentially improves assessment of individual urgency and might improve utilization of available organs.

Keywords: Liver Transplantation, Mortality, Waiting Lists, Adolescent, End stage liver disease, Risk Factors, Survival Rate, Time Factors, Tissue and Organ Procurement, young adult

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358