Disease‐specific waitlist outcomes in liver transplantation – a retrospective study

Abstract

This study aimed to evaluate possible discrepancies in waitlist outcomes between liver diseases, including alcohol‐related liver disease (ALD), nonalcoholic steatohepatitis (NASH), hepatitis C virus infection (HCV), primary biliary cirrhosis (PBC), and primary sclerosing cholangitis (PSC). Patients registered for liver transplantation from January 11, 2016, to June 30, 2018, were evaluated using OPTN/UNOS registry. Waitlist outcomes were compared between the five‐disease groups. Patients were categorized by initial MELD‐Na‐score (6–20, 21–29, and ≥30) to identify outcome variations. Prognostic impact of transplantation was assessed according to final MELD‐Na scores using Cox regression analysis modeling transplantation as a time‐dependent covariate. 6053 with ALD, 3814 with NASH, 1558 with HCV, 602 with PBC, and 819 with PSC were eligible. Compared to ALD with comparable MELD‐Na‐scores, NASH with lower [adjusted hazard ratio (aHR) = 1.30, P = 0.042] and mid‐scores (aHR = 1.35, P = 0.008) showed significantly higher risk of 1‐year waitlist mortality, and PBC with higher scores showed significantly higher risk of 90‐day (aHR = 1.69, P = 0.03) and 1‐year waitlist mortality (aHR = 1.69, P = 0.02). Positive prognostic impact of transplantation was not seen until score of 24–27 in ALD, 18–20 in HCV, 15–17 in NASH, and 24–27 in PBC and PSC. There are significant differences in waitlist outcomes among etiologies, which may differ the optimal transplant timing.