TY  - JOUR
JF  - Hepatology
AV  - public
IS  - 1
KW  - cirrhosis
KW  -  liver transplantation
KW  -  portal hypertension
KW  -  organ allocation
KW  -  MELD score
SP  - 334
EP  - 345
N2  - Patients listed for liver transplantation (LT) as status-1a currently receive the highest priority on the waiting list. The presence of acute on chronic liver failure with three or more organs failing (ACLF-3) portends low survival without transplantation, which may not be reflected by the model for end-stage liver disease-sodium (MELD-Na) score. We compared short-term waitlist mortality for patients listed status-1a and those with ACLF-3 at listing. Data was analyzed from the United Network for Organ Sharing (UNOS) database, years 2002-2014 for 3,377 patients listed status- 1a and 5,099 patients with ACLF-3. Candidates with ACLF were identified based on the EASLCLIF criteria. MELD-Na score was treated as a categorical variable of scores <36, between 36- 40 and >40. We used competing risks regression to assess waitlist mortality risk. Evaluation of outcomes through 21 days after listing demonstrated a rising trend in mortality among ACLF-3 patients at 7 days (18.0%), 14 days (27.7%) and 21 days (32.7%) (p<0.001), compared to a stable trend in mortality among individuals listed as status-1a at 7 days (17.9%), 14 days (19.3%) and 21 days (19.8%), (p=0.709). Multivariable modeling with adjustment for MELD-Na category revealed that patients with ACLF-3 had significantly greater mortality (SHR=1.45, 95% CI 1.31-1.61) within 14 days of listing compared to status-1a candidates. Analysis of the interaction between MELD-Na category and ACLF-3 showed patients with ACLF-3 had greater risk of 14-day mortality than status-1a listed patients, across all three MELD-Na categories. Conclusion: Patients with ACLF-3 at the time of listing have greater 14-day mortality than those listed as status-1a, independent of MELD-Na score. These findings illustrate the importance of early transplant evaluation and consideration of transplant priority for patients with ACLF-3.
UR  - https://doi.org/10.1002/hep.30624
VL  - 70
A1  - Jalan, R
A1  - Sundaram, V
A1  - Shah, P
A1  - Wong, R
A1  - Karvellas, C
A1  - Fortune, B
A1  - Mahmud, N
A1  - Kuo, A
ID  - discovery10070161
PB  - Wiley-Blackwell
N1  - This version is the author accepted manuscript. For information on re-use, please refer to the publisher?s terms and conditions.
Y1  - 2019/07//
TI  - Patients With Acute on Chronic Liver Failure Grade 3 Have Greater 14?Day Waitlist Mortality Than Status?1a Patients
ER  -