No Improvement in Intention-to-treat Survival and Increasing Liver Nonutilization Rate During the MELD Era.
Journal
Transplantation
ISSN: 1534-6080
Titre abrégé: Transplantation
Pays: United States
ID NLM: 0132144
Informations de publication
Date de publication:
16 Apr 2024
16 Apr 2024
Historique:
medline:
16
4
2024
pubmed:
16
4
2024
entrez:
16
4
2024
Statut:
aheadofprint
Résumé
Although post liver transplant survival rates have significantly improved during the past 2-3 decades, the trend in intention-to-treat (ITT) survival (survival from waitlist addition) has not been well studied. We conducted a retrospective analysis of Scientific Registry of Transplant Recipients data to determine the trend in ITT survival in liver transplant candidates. Adult (age ≧ 18 y) patients who were on the waitlist between the time period of March 1, 2002, to December 31, 2019 (n = 200 816) and deceased liver donors that were registered between the same time period (n = 152 593) were analyzed. We found a constant increase in posttransplant survival rates; however, the ITT survival rates showed no statistically significant improvement through the study period. We observed significant linear increase in waitlist dropout rates over time. We also observed linear increase in liver nonutilization rate in both entire cases and brain-dead cases. Donor risk index increased significantly over the years; however, it was mostly driven by increase in donation after circulatory death cases; without donation after circulatory death cases, donor risk index was stable throughout the 17 y we observed. The reason of the increased liver nonutilization rate is unclear; however, it is possible that reluctance to use high-risk organ to maintain better posttransplant outcomes contributed to this increase, which also could have led to increase in waitlist dropout rates and no improvements in ITT survival. Further investigation is warranted on the increased nonutilization rates to improve over all contribution of liver transplant to patient care.
Sections du résumé
BACKGROUND
BACKGROUND
Although post liver transplant survival rates have significantly improved during the past 2-3 decades, the trend in intention-to-treat (ITT) survival (survival from waitlist addition) has not been well studied.
METHODS
METHODS
We conducted a retrospective analysis of Scientific Registry of Transplant Recipients data to determine the trend in ITT survival in liver transplant candidates. Adult (age ≧ 18 y) patients who were on the waitlist between the time period of March 1, 2002, to December 31, 2019 (n = 200 816) and deceased liver donors that were registered between the same time period (n = 152 593) were analyzed.
RESULTS
RESULTS
We found a constant increase in posttransplant survival rates; however, the ITT survival rates showed no statistically significant improvement through the study period. We observed significant linear increase in waitlist dropout rates over time. We also observed linear increase in liver nonutilization rate in both entire cases and brain-dead cases. Donor risk index increased significantly over the years; however, it was mostly driven by increase in donation after circulatory death cases; without donation after circulatory death cases, donor risk index was stable throughout the 17 y we observed.
CONCLUSIONS
CONCLUSIONS
The reason of the increased liver nonutilization rate is unclear; however, it is possible that reluctance to use high-risk organ to maintain better posttransplant outcomes contributed to this increase, which also could have led to increase in waitlist dropout rates and no improvements in ITT survival. Further investigation is warranted on the increased nonutilization rates to improve over all contribution of liver transplant to patient care.
Identifiants
pubmed: 38622762
doi: 10.1097/TP.0000000000005018
pii: 00007890-990000000-00729
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no funding or conflicts of interest.
Références
Zanetto A, Shalaby S, Gambato M, et al. New indications for liver transplantation. J Clin Med. 2021;10:3867.
Ivanics T, Abreu P, Martin ED, et al. Changing trends in liver transplantation: challenges and solutions. Transplantation. 2021;105:743–756.
Kwong AJ, Kim WR, Lake JR, et al. OPTN/SRTR 2019 annual data report: liver. Am J Transplant. 2021;21:208–315.
Jay C, Schold JD. Measuring transplant center performance: the goals are not controversial but the methods and consequences can be. Curr Transplant Rep. 2017;4:52–58.
Hamilton TE. Improving organ transplantation in the United States—a regulatory perspective. Am J Transplant. 2008;8:2503–2505.
Department of Health and Human Services. Medicare program; hospital conditions of participation: requirements for approval and re-approval of transplant centers to perform organ transplants; final rule. Fed Regist. 2007;72:15198–15280.
Adler JT, Axelrod DA. Regulations’ impact on donor and recipient selection for liver transplantation: how should outcomes be measured and MELD exception scores be considered? AMA J Ethics. 2016;18:133–142.
Batra RK, Mulligan DC. Current status: meeting the regulatory goals of your liver transplant program. Curr Opin Organ Transplant. 2021;26:146–151.
Abecassis MM, Burke R, Klintmalm GB, et al.; American Society of Transplant Surgeons. American Society of Transplant Surgeons transplant center outcomes requirements—a threat to innovation. Am J Transplant. 2009;9:1279–1286.
Chandraker A, Andreoni KA, Gaston RS, et al. Time for reform in transplant program-specific reporting: AST/ASTS transplant metrics taskforce. Am J Transplant. 2019;19:1888–1895.
Orman ES, Mayorga ME, Wheeler SB, et al. Declining liver graft quality threatens the future of liver transplantation in the United States. Liver Transplant. 2015;21:1040–1050.
Kwong A, Kim WR, Lake JR, et al. OPTN/SRTR 2018 annual data report: liver. Am J Transplant. 2020;20(Suppl s1):193–299.
Giorgakis E, Mathur AK. Expedited placement to maximize utilization of marginal organs. Curr Opin Organ Transplant. 2020;25:640–646.
Israni AK, Zaun D, Rosendale JD, et al. OPTN/SRTR 2019 annual data report: deceased organ donors. Am J Transplant. 2021;21:567–604.
Rana A, Sigireddi RR, Halazun KJ, et al. Predicting liver allograft discard: the discard risk index. Transplantation. 2018;102:1520–1529.
Yi Z, Mayorga ME, Orman ES, et al. Trends in characteristics of patients listed for liver transplantation will lead to higher rates of waitlist removal due to clinical deterioration. Transplantation. 2017;101:2368–2374.