Effect of minimal listing criteria on waiting list registration for liver transplantation: a process-outcome analysis.
OBJECTIVE
To determine the level of association between minimal listing criteria (MLC) recognition and outcomes associated with waiting list registration for liver transplantation (LT).


METHODS
A total of 147 patients and 201 patients were identified as first-time referrals for LT evaluation between January 1, 1997, and November 30, 1997 (cohort A), and December 1,1997, and December 31, 1998 (cohort B), respectively. Relevant demographic and clinical information was abstracted from medical records. Minimal listing criteria were defined as a Child-Turcotte-Pugh (CTP) score of 7 or higher.


RESULTS
Patient age, sex, hepatic disease etiology, and mean CTP scores were similar between cohorts A and B. However, the proportion of registered patients in cohort B with CTP scores of 7 or higher increased significantly after formal MLC recognition (96% vs 82% for cohort A; P=.001). In cohort A, waiting list registration was based on patient age, male sex, nonalcohol-related hepatic disease, and a CTP score of 7 or higher in the absence of formal MLC. The rate of first-time patient referral was also increased in cohort B vs cohort A after formal MLC recognition (80% vs 69%, respectively; P=.002) despite similar clinical characteristics. Although the number of patients with a CTP score of 10 or higher was greater in cohort B vs cohort A, the proportion of patients with advanced end-stage liver disease was similar (29% vs 26%, respectively; P=.72).


CONCLUSIONS
The explicit recognition of MLC was strongly associated with improvements in appropriate waiting list registration for LT.
Talwalkar
Jayant A
JA
Transplant Center, Mayo Clinic, Rochester, Minn 55905, USA. talwalkar.jayant@mayo.edu
Kim
W Ray
WR
Rosen
Charles B
CB
Kamath
Patrick S
PS
Wiesner
Russell H
RH
D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D015276:Health Care Rationing / Q000379:methods; D006801:Humans; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010043:Outcome and Process Assessment, Health Care; D018579:Patient Selection; D012044:Regression Analysis; D012720:Severity of Illness Index; D009927:Tissue and Organ Procurement / Q000379:methods*; D014850:Waiting Lists