title: The survival benefit of liver transplantation.
abstract: Demand for liver transplantation continues to exceed donor organ supply. Comparing recipient survival to that of comparable candidates without a transplant can improve understanding of transplant survival benefit. Waiting list and post-transplant mortality was studied among a cohort of 12 996 adult patients placed on the waiting list between 2001 and 2003. Time-dependent Cox regression models were fitted to determine relative mortality rates for candidates and recipients. Overall, deceased donor transplant recipients had a 79% lower mortality risk than candidates (HR = 0.21; p < 0.001). At Model for End-stage Liver Disease (MELD) 18-20, mortality risk was 38% lower (p < 0.01) among recipients compared to candidates. Survival benefit increased with increasing MELD score; at the maximum score of 40, recipient mortality risk was 96% lower than that for candidates (p < 0.001). In contrast, at lower MELD scores, recipient mortality risk during the first post-transplant year was much higher than for candidates (HR = 3.64 at MELD 6-11, HR = 2.35 at MELD 12-14; both p < 0.001). Liver transplant survival benefit at 1 year is concentrated among patients at higher risk of pre-transplant death. Futile transplants among severely ill patients are not identified under current practice. With 1 year post-transplant follow-up, patients at lower risk of pre-transplant death do not have a demonstrable survival benefit from liver transplant.
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA. merionb@umich.edu
authors.forename: Robert M
authors.initials: RM
authors.lastname: Merion
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Schaubel
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Dykstra
authors.forename: Richard B
authors.initials: RB
authors.lastname: Freeman
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolfe
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000401:mortality*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D013534:Survival; D013997:Time Factors