Open AccessCurrent policy for allocation of donor livers in the Netherlands advantages primary sclerosing cholangitis patients on the liver transplantation waiting list—a retrospective study
Author(s) -
Goet Jorn C.,
Hansen Bettina E.,
Tieleman Madelon,
Hoek Bart,
Berg Aad P.,
Polak Wojciech G.,
Dubbeld Jeroen,
Porte Robert J.,
KonijnJanssen Cynthia,
Man Robert A.,
Metselaar Herold J.,
Vries Annemarie C.
Publication year - 2018
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/tri.13097
Subject(s) - medicine , primary sclerosing cholangitis , liver transplantation , waiting list , retrospective cohort study , prioritization , transplantation , liver disease , gastroenterology , disease , management science , economics
Summary Studies from the USA and Nordic countries indicate primary sclerosing cholangitis ( PSC ) patients have low mortality on the liver transplantation ( LT x) waiting list. However, this may vary among geographical areas. Therefore, we compared waiting list mortality and post‐transplant survival between laboratory model for end‐stage liver disease ( LM ) and MELD exception ( ME )‐prioritized PSC and non‐ PSC candidates in a nationwide study in the Netherlands. A retrospective analysis of patients waitlisted from 2006 to 2013 was conducted. A total of 852 candidates (146 PSC ) were waitlisted of whom 609 (71.5%) underwent LT x and 159 (18.7%) died before transplantation. None of the ME PSC patients died, and they had a higher probability of LT x than LM PSC [ HR obtained by considering ME as a time‐dependent covariate ( HR ME 9.86; 95% CI 6.14–15.85)] and ME non‐ PSC patients ( HR ME 4.60; 95% CI 3.78–5.61). After liver transplantation, PSC patients alive at 3 years of follow‐up had a higher probability of relisting than non‐ PSC patients ( HR 7.94; 95% CI 1.98–31.85) but a significantly lower mortality ( HR 0.51; 95% CI 0.27–0.95). In conclusion, current LT x prioritization advantages PSC patients on the LT x waiting list. Receiving ME points is strongly associated with timely LT x.