scholarly journals Mortality on the UNOS Waitlist for Patients with Autoimmune Liver Disease

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.

scholarly journals Risk Factors of Mortality from All Asbestos-Related Diseases: A Competing Risk Analysis

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Rafael Abós-Herràndiz ◽  
Teresa Rodriguez-Blanco ◽  
Isabel Garcia-Allas ◽  
Isabel-Magdalena Rosell-Murphy ◽  
Constança Albertí-Casas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Analysis ◽  
Incidence Rate ◽  
Hazard Analysis ◽  
Competing Risk ◽  
Competing Risk Analysis ◽  
Subdistribution Hazard ◽  
Related Disease ◽  
Asbestos Related Disease

Background. The mortality from all malignant and nonmalignant asbestos-related diseases remains unknown. The authors assessed the incidence and risk factors for all asbestos-related deaths. Methods. The sample included 544 patients from an asbestos-exposed community in the area of Barcelona (Spain), between Jan 1, 1970, and Dec 31, 2006. Competing risk regression through a subdistribution hazard analysis was used to estimate risk factors for the outcomes. Results. Asbestos-related deaths were observed in 167 (30.7%) patients and 57.5% of these deaths were caused by some type of mesothelioma. The incidence rate after diagnosis was 3,600 per 100,000 person-years. In 7.5% of patients death was non-asbestos-related, while pleural and peritoneal mesothelioma were identified in 87 (16.0%) and 18 (3.3%) patients, respectively. Conclusions. Age, sex, household exposure, cumulative nonmalignant asbestos-related disease, and single malignant pathology were identified as risk factors for asbestos-related death. These findings suggest the need to develop a preventive approach to the community and to improve the clinical follow-up process of these patients.

scholarly journals A model including sarcopenia surpasses the MELD score in predicting waiting list mortality in cirrhotic liver transplant candidates: A competing risk analysis in a national cohort

2018 ◽  
Vol 68 (4) ◽  
pp. 707-714 ◽  
Author(s):  
Jeroen Laurens Ad van Vugt ◽  
Louise Johanna Maria Alferink ◽  
Stefan Buettner ◽  
Marcia Patricia Gaspersz ◽  
Daphne Bot ◽  
...  
Keyword(s):  
Risk Analysis ◽  
Liver Transplant ◽  
Meld Score ◽  
Cirrhotic Liver ◽  
Waiting List ◽  
Competing Risk ◽  
Competing Risk Analysis ◽  
National Cohort ◽  
Transplant Candidates

scholarly journals Extra-Hepatic Comorbidity Burden Significantly Increases 90-day Mortality in Patients with Cirrhosis and High Model for Endstage Liver Disease

2020 ◽  
Author(s):  
Scott Coppel ◽  
Karan Mathur ◽  
Burcin Ekser ◽  
Kavish R Patidar ◽  
Eric Orman ◽  
...  
Keyword(s):  
Liver Disease ◽  
Risk Analysis ◽  
Competing Risk ◽  
Ageing Population ◽  
Competing Risk Analysis ◽  
Comorbidity Burden ◽  
Short Term Mortality ◽  
Cox Proportional Hazard Regression ◽  
Overall Mortality

Abstract Background & aims We examined how extra-hepatic comorbidity burden impacts mortality in patients with cirrhosis referred for liver transplantation (LT). Methods Adults with cirrhosis evaluated for their first LT in 2012 were followed through their clinical course with last follow up in 2019. Extra-hepatic comorbidity burden was measured using the Charlson Comorbidity Index (CCI). The endpoints were 90-day transplant free survival ( Cox-Proportional Hazard regression), and overall mortality (competing risk analysis). Results The study included 340 patients, mean age 56 ± 11, 63% male and MELD-Na 17.2 ± 6.6. The CCI was 0 (no comorbidities) in 44%, 1–2 in 44% and > 2 (highest decile) in 12%, with no differences based on gender but higher CCI in patients with fatty and cryptogenic liver disease. Thirty-three (10%) of 332 patients not receiving LT within 90 days died. Beyond MELD-Na, the CCI was independently associated with 90-day mortality (hazard ratio (HR), 1.32 (95% confidence interval (CI) 1.02–1.72). Ninety-day mortality was specifically increased with higher CCI category and MELD ≥ 18 (12% (CCI = 0), 22% (CCI = 1–2) and 33% (CCI > 2), (p = 0.002)) but not MELD-Na ≤ 17. At last follow-up, 69 patients were alive, 100 underwent LT and 171 died without LT. CCI was associated with increased overall mortality in the competing risk analysis (Sub-HR 1.24, 95%CI 1.1–1.4 ). Conclusions Extra-hepatic comorbidity burden significantly impacts short-term mortality in patients with cirrhosis and high MELD-Na. This has implications in determining urgency of LT and mortality models in cirrhosis and LT waitlisting, especially with an ageing population with increasing prevalence of fatty liver disease.

scholarly journals Nomogram to Predict Cause-specific Mortality of Patients with Rectal Adenocarcinoma Undergoing Surgery: A Competing Risk Analysis.

2020 ◽  
Author(s):  
Xu Zhang ◽  
Fengshuo Xu ◽  
Yadi Bin ◽  
Tianjie Liu ◽  
Zhichao Li ◽  
...  
Keyword(s):  
Risk Analysis ◽  
Calibration Curve ◽  
Survival Data ◽  
Risk Model ◽  
Univariate Analysis ◽  
Rectal Adenocarcinoma ◽  
Competing Risk ◽  
Competing Risk Analysis ◽  
Subdistribution Hazard ◽  
Specific Mortality

Abstract Background: Rectal adenocarcinoma is one of major public health problems, severely threatening people’s health and life. Cox proportional hazard models have been applied in previous studies widely to analyze survival data. However, such models ignore competing risks and treat them as censored, resulting in excessive statistical errors. Therefore, a competing-risk model was applied with the aim of decreasing risk of bias and thereby obtaining more-accurate results and establishing a competing-risk nomogram for better guiding clinical practice.Methods: A total of 22,879 rectal adenocarcinoma cases who underwent primary-site surgical resection were collected from the SEER (Surveillance, Epidemiology, and End Results) database. Death due to rectal adenocarcinoma (DRA) and death due to other causes (DOC) were two competing endpoint events in the competing-risk regression analysis. The cumulative incidence function (CIF) for DRA and DOC at each time point was calculated. Gray’s test was applied in the univariate analysis and Gray’s proportional subdistribution hazard model was adopted in the multivariate analysis to recognize significant differences among groups and obtain significant factors that could affect patients’ prognosis. Next, A competing-risk nomogram was established predicting the cause-specific outcome of rectal adenocarcinoma cases. Finally, we plotted calibration curve and calculated concordance indexes (c-index) to evaluate the model performance.Results: 22,879 patients were included finally. The results showed that age, race, marital status, chemotherapy, AJCC stage, tumor size, and number of metastasis lymph nodes were significant prognostic factors for postoperative rectal adenocarcinoma patients. We further successfully constructed a competing-risk nomogram to predict the 1-year, 3-year, and 5-year cause-specific mortality of rectal adenocarcinoma patients. The calibration curve and C-index indicated that the competing-risk nomogram model had satisfactory prognostic ability.Conclusion: Competing-risk analysis could help us obtain more-accurate results for rectal adenocarcinoma patients who had undergone surgery, which could definitely help clinicians obtain accurate prediction of the prognosis of patients and make better clinical decisions.

scholarly journals Extra-Hepatic Comorbidity Burden Significantly Increases 90-day Mortality in Patients with Cirrhosis and High Model for Endstage Liver Disease

2020 ◽  
Author(s):  
Scott Coppel ◽  
Karan Mathur ◽  
Burcin Ekser ◽  
Kavish R Patidar ◽  
Eric Orman ◽  
...  
Keyword(s):  
Liver Disease ◽  
Risk Analysis ◽  
Competing Risk ◽  
Ageing Population ◽  
Competing Risk Analysis ◽  
Comorbidity Burden ◽  
Short Term Mortality ◽  
Cox Proportional Hazard Regression ◽  
Overall Mortality

Abstract BackgroundWe examined how extra-hepatic comorbidity burden impacts mortality in patients with cirrhosis referred for liver transplantation (LT).MethodsAdults with cirrhosis evaluated for their first LT in 2012 were followed through their clinical course with last follow up in 2019. Extra-hepatic comorbidity burden was measured using the Charlson Comorbidity Index (CCI). The endpoints were 90-day transplant free survival (Cox-Proportional Hazard regression), and overall mortality (competing risk analysis).ResultsThe study included 340 patients, mean age 56±11, 63% male and MELD-Na 17.2±6.6. The CCI was 0 (no comorbidities) in 44%, 1-2 in 44% and >2 (highest decile) in 12%, with no differences based on gender but higher CCI in patients with fatty and cryptogenic liver disease. Thirty-three (10%) of 332 patients not receiving LT within 90 days died. Beyond MELD-Na, the CCI was independently associated with 90-day mortality (hazard ratio (HR), 1.32 (95% confidence interval (CI) 1.02–1.72). Ninety-day mortality was specifically increased with higher CCI category and MELD ≥ 18 (12% (CCI=0), 22% (CCI=1-2) and 33% (CCI>2), (p=0.002)) but not MELD-Na ≤17. At last follow-up, 69 patients were alive, 100 underwent LT and 171 died without LT. CCI was associated with increased overall mortality in the competing risk analysis (Sub-HR 1.24, 95%CI 1.1-1.4 ).ConclusionsExtra-hepatic comorbidity burden significantly impacts short-term mortality in patients with cirrhosis and high MELD-Na. This has implications in determining urgency of LT and mortality models in cirrhosis and LT waitlisting, especially with an ageing population with increasing prevalence of fatty liver disease.

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

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.

scholarly journals Extra-hepatic comorbidity burden significantly increases 90-day mortality in patients with cirrhosis and high model for endstage liver disease

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Scott Coppel ◽  
Karan Mathur ◽  
Burcin Ekser ◽  
Kavish R. Patidar ◽  
Eric Orman ◽  
...  
Keyword(s):  
Liver Disease ◽  
Risk Analysis ◽  
Competing Risk ◽  
Ageing Population ◽  
Competing Risk Analysis ◽  
Comorbidity Burden ◽  
Short Term Mortality ◽  
Cox Proportional Hazard Regression ◽  
Overall Mortality

Abstract Background We examined how extra-hepatic comorbidity burden impacts mortality in patients with cirrhosis referred for liver transplantation (LT). Methods Adults with cirrhosis evaluated for their first LT in 2012 were followed through their clinical course with last follow up in 2019. Extra-hepatic comorbidity burden was measured using the Charlson Comorbidity Index (CCI). The endpoints were 90-day transplant free survival (Cox-Proportional Hazard regression), and overall mortality (competing risk analysis). Results The study included 340 patients, mean age 56 ± 11, 63% male and MELD-Na 17.2 ± 6.6. The CCI was 0 (no comorbidities) in 44%, 1–2 in 44% and > 2 (highest decile) in 12%, with no differences based on gender but higher CCI in patients with fatty and cryptogenic liver disease. Thirty-three (10%) of 332 patients not receiving LT within 90 days died. Beyond MELD-Na, the CCI was independently associated with 90-day mortality (hazard ratio (HR), 1.32 (95% confidence interval (CI) 1.02–1.72). Ninety-day mortality was specifically increased with higher CCI category and MELD ≥18 (12% (CCI = 0), 22% (CCI = 1–2) and 33% (CCI > 2), (p = 0.002)) but not MELD-Na ≤17. At last follow-up, 69 patients were alive, 100 underwent LT and 171 died without LT. CCI was associated with increased overall mortality in the competing risk analysis (Sub-HR 1.24, 95%CI 1.1–1.4). Conclusions Extra-hepatic comorbidity burden significantly impacts short-term mortality in patients with cirrhosis and high MELD-Na. This has implications in determining urgency of LT and mortality models in cirrhosis and LT waitlisting, especially with an ageing population with increasing prevalence of fatty liver disease.

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