title: Recipient ineligibility after liver transplantation assessment: a single centre experience.
abstract: BACKGROUND
  Candidacy for liver transplantation is determined through standardized evaluation. There are limited data on the frequency and reasons for denial of transplantation after assessment; analysis may shed light on the short-term utility of the assessment. We sought to describe the frequency and reasons for ineligibility for liver transplantation among referred adults.
  
  
  METHODS
  We studied all prospectively followed recipient candidates at a single centre who were deemed unsuitable for liver transplantation after assessment. Inclusion criteria were age 18 years and older and completion of a standard liver transplantation evaluation over a 3-year period. Patients were excluded if they had a history of prior assessment or liver transplantation within the study period. Demographic and baseline clinical data and reasons for recipient ineligibility were recorded.
  
  
  RESULTS
  In all, 337 patients underwent their first liver transplantation evaluation during the study period; 166 (49.3%) fulfilled inclusion criteria. The mean age was 55.4 years, and 106 (63.9%) were men. The 3 most common reasons for denial of listing were patient too well (n = 82, 49.4%), medical comorbidities and/or need for medical optimization (n = 43, 25.9%) and need for addiction rehabilitation (n = 28, 16.9%).
  
  
  CONCLUSIONS
  Ineligibility for transplantation after assessment was common, occurring in nearly half of the cohort. Most denied candidates could be identified with more discriminate screening before the resource-intensive assessment; however, the assessment likely provides unforeseen positive impacts on patient care.
authors.affiliation: The Division of Gastroenterology, the Multiorgan Transplant Program, Western University, London, Ont., Canada.
authors.forename: Aman
authors.initials: A
authors.lastname: Arya
authors.forename: Roberto
authors.initials: R
authors.lastname: Hernandez-Alejandro
authors.forename: Paul
authors.initials: P
authors.lastname: Marotta
authors.forename: Julia
authors.initials: J
authors.lastname: Uhanova
authors.forename: Natasha
authors.initials: N
authors.lastname: Chandok
mesh_terms: D000328:Adult; D002170:Canada; D015331:Cohort Studies; D004608:Eligibility Determination / Q000458:organization & administration* / Q000706:statistics & numerical data; D058625:End Stage Liver Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006304:Health Status; D006801:Humans; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011785:Quality Assurance, Health Care; D012720:Severity of Illness Index; D009927:Tissue and Organ Procurement / Q000458:organization & administration* / Q000706:statistics & numerical data