The Survival Benefit of Liver Transplantation

Authors

  • Robert M. Merion,

    Corresponding author
    1. Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
    2. Scientific Registry of Transplant Recipients, Ann Arbor, Michigan, USA
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  • Douglas E. Schaubel,

    1. Scientific Registry of Transplant Recipients, Ann Arbor, Michigan, USA
    2. Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
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  • Dawn M. Dykstra,

    1. Scientific Registry of Transplant Recipients, Ann Arbor, Michigan, USA
    2. University Renal Research and Education Association, Ann Arbor, Michigan, USA
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  • Richard B. Freeman,

    1. Tufts-New England Medical Center, Boston, Massachusetts, USA
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  • Friedrich K. Port,

    1. Scientific Registry of Transplant Recipients, Ann Arbor, Michigan, USA
    2. University Renal Research and Education Association, Ann Arbor, Michigan, USA
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  • Robert A. Wolfe

    1. Scientific Registry of Transplant Recipients, Ann Arbor, Michigan, USA
    2. Department of Biostatistics, University of Michigan, Ann Arbor, Michigan, USA
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*Corresponding author: Robert M. Merion, merionb@umich.edu

Abstract

Demand for liver transplantation continues to exceed donor organ supply. Comparing recipient survival to that of comparable candidates without a transplant can improve understanding of transplant survival benefit. Waiting list and post-transplant mortality was studied among a cohort of 12 996 adult patients placed on the waiting list between 2001 and 2003. Time-dependent Cox regression models were fitted to determine relative mortality rates for candidates and recipients. Overall, deceased donor transplant recipients had a 79% lower mortality risk than candidates (HR = 0.21; p < 0.001). At Model for End-stage Liver Disease (MELD) 18–20, mortality risk was 38% lower (p < 0.01) among recipients compared to candidates. Survival benefit increased with increasing MELD score; at the maximum score of 40, recipient mortality risk was 96% lower than that for candidates (p < 0.001). In contrast, at lower MELD scores, recipient mortality risk during the first post-transplant year was much higher than for candidates (HR = 3.64 at MELD 6–11, HR = 2.35 at MELD 12–14; both p < 0.001). Liver transplant survival benefit at 1 year is concentrated among patients at higher risk of pre-transplant death. Futile transplants among severely ill patients are not identified under current practice. With 1 year post-transplant follow-up, patients at lower risk of pre-transplant death do not have a demonstrable survival benefit from liver transplant.

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