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Transplantation. 2018 Nov 21. doi: 10.1097/TP.0000000000002526. [Epub ahead of print]

Outcome of liver transplant patients with high urgent priority. Are we doing the right thing?

Author information

1
Medical Staff.
2
Division of Transplantation, Department of Surgery.
3
Department of Medical Statistics.
4
Data Manager.
5
Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik, Bonn, Germany.
6
Department of Transplantation and Surgery, Semmelweis Medical University, Budapest, Hungary.
7
Department of Gastroenterology, Leiden University Medical Center, Leiden, The Netherlands.
8
Klinik fur Allgemeine, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schleswig-Holstein Campus Kiel, Kiel, Germany.
9
Department of Gastroenterology, University Medical Center Groningen, Groningen, The Netherlands.
10
Department of Surgery, Clinical Hospital Merkur, Zagreb, Croatia.
11
Department of Gastroenterology and Hepatology, University Hospital Antwerp, Antwerpen, Belgium.
12
Department of Abdominal Surgery, University Medical Center Ljubljana, Ljubljana, Slovenia.
13
Medical Director, Eurotransplant International Foundation, Leiden, the Netherlands.
14
Division of Transplantation, Department of Surgery, Medical University of Vienna, Austria.
15
Department of General-, Visceral-, and Transplant Surgery, University of Munich, Campus Grosshadern, Germany.

Abstract

BACKGROUND:

About 15% of liver transplantations in Eurotransplant are currently performed in patients with a high-urgency (HU) status. Patients that have acute liver failure or require an acute retransplantation can apply for this status. This study aims to evaluate the efficacy of this prioritization.

METHODS:

Patients that were listed for liver transplantation with HU status from 01.01.2007 up to 31.12.2015 were included. Waiting list and posttransplantation outcomes were evaluated and compared with a reference group of patients with labMELD scores ≥40 (MELD 40+).

RESULTS:

In the study period, 2,299 HU patients were listed for liver transplantation. At 10 days after listing, 72% of all HU patients were transplanted and 14% of patients deceased. Patients with HU status for primary acute liver failure showed better patient survival at 3 years (69%) as compared to patients in the MELD 40+ group (57%). HU patients with labMELD≥45 and patients with HU status for acute retransplantation and LabMELD≥35 have significantly inferior survival at 3-year follow-up of 46% and 42%, respectively.

CONCLUSIONS:

Current prioritization for patients with acute liver failure is highly effective in preventing mortality on the waiting list. Although patients with HU status for acute liver failure have good outcomes, survival is significantly inferior for patients with a high MELD score or for retransplantations. With the current scarcity of livers in mind, we should discuss whether potential recipients for a second or even third retransplantation should still receive absolute priority, with HU-status, over other recipients with an expected, substantially better prognosis after transplantation.

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