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Waitlist mortality in patients with autoimmune liver diseases
Daniela Goyes1, Romelia Barba2, Esli Medina-Morales2
1Department of Medicine, Loyola Medicine-MacNeal Hospital, Berwyn, IL, United States.
Annals of Hepatology
|July 14, 2022
Summary
Patients with autoimmune liver diseases, including autoimmune hepatitis and primary biliary cholangitis, face higher risks of waitlist removal for liver transplants. Current allocation systems may underestimate disease severity, necessitating a review of MELD exception points.
Area of Science:
- Hepatology
- Transplantation Medicine
- Immunology
Background:
- Autoimmune liver diseases (AILDs) like autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) account for approximately 24% of liver transplants.
- The Model for End-Stage Liver Disease (MELD) score, used for liver transplant allocation, may not accurately reflect the severity of AILDs.
- Adverse outcomes on the liver transplant waitlist, including death or clinical deterioration leading to removal, are a critical concern.
Purpose of the Study:
- To compare the rate of adverse waitlist removal among patients with AILDs versus other indications for liver transplantation.
- To evaluate the effectiveness of the current liver transplant allocation system in managing patients with AILDs.
Main Methods:
- Utilized the United Network for Organ Sharing (UNOS) database to identify patients listed for liver transplant between 2016 and 2019.
- Defined waitlist survival as a composite outcome of death or removal due to clinical deterioration.
- Employed competing risk analysis to assess waitlist survival rates.
Main Results:
- Patients with autoimmune hepatitis (AIH) showed a significantly higher risk of waitlist removal (SHR 1.37, P<0.007).
- Patients with primary biliary cholangitis (PBC) also exhibited an increased risk of waitlist removal (SHR 1.34, P<0.011).
- These findings indicate a disparity in waitlist outcomes for patients with specific AILDs compared to other liver disease etiologies.
Conclusions:
- Patients with AIH and PBC experience higher rates of waitlist death or clinical deterioration, suggesting an underestimation of disease severity by the MELD score.
- Reassessment of the MELD exception point system is recommended to address the disparities in liver transplant allocation for patients with AILDs.
- Optimizing the allocation system can improve waitlist survival and ensure equitable access to liver transplantation for all patients.
