Abstract
Background and Aims
Patients with acute-on-chronic liver failure (ACLF) show excess mortality in MELD-Na
based organ allocation for liver transplantation (LT). Whether MELD-based allocation
in the Eurotransplant region similarly underprioritizes ACLF patients is unknown.
Methods
428 patients listed for LT from 01/2010 to 02/2021 at a tertiary center in Germany
were screened and 209 patients included as derivation (n = 123) and validation cohort (n = 86). Competing risk analysis for waitlist mortality and LT as competing events
was performed.
Results
90-day waitlist mortality for patients with MELD < and ≥ 25 at baseline was 9% vs.
33%, respectively (p = 0.009). Competing risk analysis shows significantly higher 90-day waitlist mortality
in patients listed with ACLF compared to those without ACLF (p = 0.021) in the low MELD stratum. Probability of LT was similar between the two groups
(p = 0.91). In the high MELD group, 90-day waitlist mortality and rates of LT were not
significantly different between patients with and without ACLF (31% vs. 20%, p = 0.55 and 59% vs. 60%, p = 0.72, respectively). Post-transplant survival was similar between patients with
and without ACLF. This result was confirmed in the validation cohort.
Conclusion
MELD-based organ allocation in the Eurotransplant region underestimates waitlist mortality
in patients with ACLF in lower MELD ranges.
Keywords
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Article info
Publication history
Published online: January 04, 2022
Accepted:
December 16,
2021
Received:
May 21,
2021
Identification
Copyright
© 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
