Open AccessPredictors of Outcomes of Patients Referred to a Transplant Center for Urgent Liver Transplantation Evaluation
Author(s) -
Alshuwaykh Omar,
Kwong Allison,
Goel Aparna,
Cheung Amanda,
Dhanasekaran Renumathy,
Ahmed Aijaz,
Daugherty Tami,
Dronamraju Deepti,
Kumari Radhika,
Kim W. Ray,
Nguyen Mindie H.,
Esquivel Carlos O.,
Concepcion Waldo,
Melcher Marc,
Bonham Andy,
Pham Thomas,
Gallo Amy,
Kwo Paul Yien
Publication year - 2021
Publication title -
hepatology communications
Language(s) - English
Resource type - Journals
ISSN - 2471-254X
DOI - 10.1002/hep4.1644
Subject(s) - liver transplantation , medicine , center (category theory) , transplantation , single center , intensive care medicine , chemistry , crystallography
Liver transplantation (LT) is definitive treatment for end‐stage liver disease. This study evaluated factors predicting successful evaluation in patients transferred for urgent inpatient LT evaluation. Eighty‐two patients with cirrhosis were transferred for urgent LT evaluation from January 2016 to December 2018. Alcohol‐associated liver disease was the common etiology of liver disease (42/82). Of these 82 patients, 35 (43%) were declined for LT, 27 (33%) were wait‐listed for LT, 5 (6%) improved, and 15 (18%) died. Psychosocial factors were the most common reasons for being declined for LT (49%). Predictors for listing and receiving LT on multivariate analysis included Hispanic race (odds ratio [OR], 1.89; P = 0.003), Asian race (OR, 1.52 ; P = 0.02), non‐Hispanic ethnicity (OR, 1.49 ; P = 0.04), hyponatremia (OR, 1.38; P = 0.04), serum albumin (OR, 1.13 ; P = 0.01), and Model for End‐Stage Liver Disease (MELD)‐Na (OR, 1.02 ; P = 0.003). Public insurance (i.e., Medicaid) was a predictor of not being listed for LT on multivariate analysis (OR, 0.77 ; P = 0.02). Excluding patients declined for psychosocial reasons, predictors of being declined for LT on multivariate analysis included Chronic Liver Failure Consortium (CLIF‐C) score >51.5 (OR, 1.26 ; P = 0.03), acute‐on‐chronic liver failure (ACLF) grade 3 (OR, 1.41 ; P = 0.01), hepatorenal syndrome (HRS) (OR, 1.38 ; P = 0.01), and respiratory failure (OR, 1.51 ; P = 0.01). Predictors of 3‐month mortality included CLIF‐C score >51.5 (hazard ratio [HR], 2.52; P = 0.04) and intensive care unit (HR, 8.25 ; P < 0.001). Conclusion: MELD‐Na, albumin, hyponatremia, ACLF grade 3, HRS, respiratory failure, public insurance, Hispanic race, Asian race, and non‐Hispanic ethnicity predicted liver transplant outcome. Lack of psychosocial support was a major reason for being declined for LT. The CLIF‐C score predicted being declined for LT and mortality.