A nomogram with sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant patients: a competing risk analysis in a national cohort

ABSTRACT BACKGROUND: In Brazil, the Model for End-Stage Liver Disease (MELD) score is used to prioritize patients for deceased donor liver transplantation (DDLT). Patients with hepatocellular carcinoma (HCC) receive standardized MELD exception points to account for their cancer risk of mortality, which is not reflected by their MELD score. OBJECTIVE: To compare DDLT rates between patients with and without HCC in Rio Grande do Sul, the Southernmost state of Brazil. METHODS - We retrospectively studied 825 patients on the liver-transplant waiting list from January 1, 2007, to December 31, 2016, in a transplant center located in Porto Alegre, the capital of Rio Grande do Sul, to compare DDLT rates between those with and without HCC. The time-varying hazard of waiting list/DDLT was estimated, reporting the subhazard ratio (SHR) of waiting list/DDLT/dropout with 95% confidence intervals (CI). The final competing risk model was adjusted for age, MELD score, exception points, and ABO group. RESULTS: Patients with HCC underwent a transplant almost three times faster than patients with a calculated MELD score (SHR 2.64; 95% CI 2.10-3.31; P<0.001). The DDLT rate per 100 person-months was 11.86 for HCC patients vs 3.38 for non-HCC patients. The median time on the waiting list was 5.6 months for patients with HCC and 25 months for patients without HCC. CONCLUSION: Our results demonstrated that, in our center, patients on the waiting list with HCC have a clear advantage over candidates listed with a calculated MELD score.

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Mortality on the UNOS Waitlist for Patients with Autoimmune Liver Disease

Journal of Clinical Medicine ◽

10.3390/jcm9020319 ◽

2020 ◽

Vol 9 (2) ◽

pp. 319

Author(s):

Jaspreet S. Suri ◽

Christopher J. Danford ◽

Vilas Patwardhan ◽

Alan Bonder

Keyword(s):

Liver Disease ◽

Risk Analysis ◽

Liver Transplant ◽

Autoimmune Hepatitis ◽

Competing Risk ◽

Clinical Deterioration ◽

Primary Biliary Cholangitis ◽

Competing Risk Analysis ◽

Subdistribution Hazard ◽

Similar Risk

Background: Outcomes on the liver transplant waitlist can vary by etiology. Our aim is to investigate differences in waitlist mortality of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) using the United Network for Organ Sharing (UNOS) database. Methods: We identified patients who were listed for liver transplantation from 1987 to 2016 with a primary diagnosis of AIH, PBC, or PSC. We excluded patients with overlap syndromes, acute hepatic necrosis, missing data, and those who were children. The primary outcome was death or removal from the waitlist due to clinical deterioration. We compared waitlist survival using competing risk analysis. Results: Between 1987 and 2016, there were 7412 patients listed for liver transplant due to AIH, 8119 for PBC, and 10,901 for PSC. Patients with AIH were younger, more likely to be diabetic, and had higher listing model for end-stage liver disease (MELD) scores compared to PBC and PSC patients. Patients with PBC and AIH were more likely to be removed from the waitlist due to death or clinical deterioration. On competing risk analysis, AIH patients had a similar risk of being removed from the waitlist compared to those with PBC (subdistribution hazard ratio (SHR) 0.94, 95% CI 0.85–1.03) and higher risk of removal compared to those with PSC (SHR 0.8, 95% CI 0.72 to 0.89). Conclusion: Autoimmune hepatitis carries a similar risk of waitlist removal to PBC and a higher risk than PSC. The etiology of this disparity is not entirely clear and deserves further investigation.

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Visit-to-visit variability of fasting plasma glucose as predictor of ischemic stroke: competing risk analysis in a national cohort of Taiwan Diabetes Study

BMC Medicine ◽

10.1186/s12916-014-0165-7 ◽

2014 ◽

Vol 12 (1) ◽

Cited By ~ 45

Author(s):

Cheng-Chieh Lin ◽

Chun-Pai Yang ◽

Chia-Ing Li ◽

Chiu-Shong Liu ◽

Ching-Chu Chen ◽

...

Keyword(s):

Ischemic Stroke ◽

Risk Analysis ◽

Plasma Glucose ◽

Fasting Plasma Glucose ◽

Competing Risk ◽

Competing Risk Analysis ◽

Fasting Plasma ◽

National Cohort

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Waitlist Mortality and Posttransplant Outcomes in African Americans with Autoimmune Liver Diseases

Journal of Transplantation ◽

10.1155/2021/6692049 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

John Paul Nsubuga ◽

Daniela Goyes ◽

Hirsh D. Trivedi ◽

Esli Medina-Morales ◽

Vilas Patwardhan ◽

...

Keyword(s):

African Americans ◽

Risk Analysis ◽

Liver Transplant ◽

Graft Survival ◽

Liver Diseases ◽

Cox Regression ◽

Survival Rates ◽

Competing Risk ◽

Competing Risk Analysis ◽

Autoimmune Liver Diseases

Background. Liver transplantation is indicated in end-stage liver disease due to autoimmune diseases. The liver allocation system can be affected by disparities such as decreased liver transplant referrals for racial minorities, especially African Americans that negatively impact the pre- and posttransplant outcomes. Aim. To determine differences in waitlist survival and posttransplant graft survival rates between African American and Caucasian patients with autoimmune liver diseases. Study. The United Network for Organ Sharing database was used to identify all patients with autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis who underwent liver transplant from 1988 to 2019. We compared waitlist survival and posttransplant graft survival between Caucasians and African Americans using Kaplan–Meier curves and Cox regression models. We also evaluated the cumulative incidence of death or delisting for deterioration and posttransplant incidence of death and retransplantation using competing risk analysis. Results. African Americans were more likely to be removed from the waitlist for death or clinical deterioration (subdistribution hazard ratio (SHR) 1.26, 95% CI 1–1.58, P = 0.046 ) using competing risk analysis. On multivariate Cox regression analysis, there was no difference in posttransplant graft survival among the two groups (hazard ratio (HR) 1.10, 95% CI 0.98–1.23, P = 0.081 ). Conclusions. Despite the current efforts to reduce racial disparities, we found that African Americans are more likely to die on the waitlist for liver transplant and are less likely to be transplanted, with no differences in graft survival rates. The persistence of healthcare disparities continues to negatively impact African Americans.

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