Trajectories of patients relisted for liver transplantation
Introduction and Objectives: Recurrent cirrhosis complicates 10-30% of Liver transplants (LT) and can lead to consideration for re-transplantation. We evaluated the trajectories of relisted versus primary listed patients on the waitlist using a competing risk framework. Materials and Methods: We ret...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-01-01
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| Series: | Annals of Hepatology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1665268123002715 |
| _version_ | 1797627110133596160 |
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| author | Fakhar Ali Qazi Arisar Rhea Varghese Shiyi Chen Wei Xu Markus Selzner Ian McGilvray Blayne Sayed Trevor Reichman Chaya Shwaartz Mark Cattral Anand Ghanekar Gonzalo Sapisochin Elmar Jaeckel Cynthia Tsien Nazia Selzner Leslie Lilly Mamatha Bhat |
| author_facet | Fakhar Ali Qazi Arisar Rhea Varghese Shiyi Chen Wei Xu Markus Selzner Ian McGilvray Blayne Sayed Trevor Reichman Chaya Shwaartz Mark Cattral Anand Ghanekar Gonzalo Sapisochin Elmar Jaeckel Cynthia Tsien Nazia Selzner Leslie Lilly Mamatha Bhat |
| author_sort | Fakhar Ali Qazi Arisar |
| collection | DOAJ |
| description | Introduction and Objectives: Recurrent cirrhosis complicates 10-30% of Liver transplants (LT) and can lead to consideration for re-transplantation. We evaluated the trajectories of relisted versus primary listed patients on the waitlist using a competing risk framework. Materials and Methods: We retrospectively examined 1,912 patients listed for LT at our centre between from 2012 to 2020. Cox proportional hazard models were used to assess overall survival (OS) by listing type and competing risk analysis Fine-Gray models were used to assess cumulative incidence of transplant by listing type. Results: 1,731 patients were included (104 relisted). 44.2% of relisted patients received exception points vs. 19.8% of primary listed patients (p<0.001). Patients relisted without exceptions, representing those with graft cirrhosis, had the worst OS (HR: 4.17, 95%CI 2.63 – 6.67, p=<0.0001) and lowest instantaneous rate of transplant (HR: 0.56, 95%CI 0.38 – 0.83, p=0.006) than primary listed with exception points. On multivariate analysis listing type, height, bilirubin and INR were associated with cumulative incidence of transplant, while listing type, bilirubin, INR, sodium, creatinine were associated with OS. Within relisted patients, there was a trend towards higher mortality (HR: 1.79, 95%CI 0.91 – 3.52, p=0.08) and low transplant incidence (HR: 0.51, 95%CI 0.22 – 1.15, p=0.07) for graft cirrhosis vs other relisting indications. Conclusions: Patients relisted for LT are carefully curated and comprise a minority of the waitlist population. Despite their younger age, they have worse liver/kidney function, poor waitlist survival, and decreased transplant incidence suggesting the need for early relisting, while considering standardized exception points. |
| first_indexed | 2024-03-11T10:19:44Z |
| format | Article |
| id | doaj.art-7f9ac428ce9b43c1936117868c3d8bc2 |
| institution | Directory Open Access Journal |
| issn | 1665-2681 |
| language | English |
| last_indexed | 2024-03-11T10:19:44Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj.art-7f9ac428ce9b43c1936117868c3d8bc22023-11-16T06:09:32ZengElsevierAnnals of Hepatology1665-26812024-01-01291101168Trajectories of patients relisted for liver transplantationFakhar Ali Qazi Arisar0Rhea Varghese1Shiyi Chen2Wei Xu3Markus Selzner4Ian McGilvray5Blayne Sayed6Trevor Reichman7Chaya Shwaartz8Mark Cattral9Anand Ghanekar10Gonzalo Sapisochin11Elmar Jaeckel12Cynthia Tsien13Nazia Selzner14Leslie Lilly15Mamatha Bhat16University Health Network, 585 University Avenue, Toronto, M5G 2N2, Canada; University of Toronto, 27 King's College Clr, Toronto, M5S 1A1, CanadaUniversity Health Network, 585 University Avenue, Toronto, M5G 2N2, Canada; McMaster University, Faculty of Health Sciences, 1280 Main St W, Hamilton, ON L8S 4L8, Hamilton, CanadaUniversity of Toronto, 27 King's College Clr, Toronto, M5S 1A1, Canada; Princess Margaret Cancer Centre, 620 University Ave, Toronto, ON M5G 2C1, CanadaUniversity of Toronto, 27 King's College Clr, Toronto, M5S 1A1, Canada; Princess Margaret Cancer Centre, 620 University Ave, Toronto, ON M5G 2C1, Canada; Dalla Lana School of Public Health, 155 College St Room 500, Toronto, M5T 3M7 CanadaUniversity Health Network, 585 University Avenue, Toronto, M5G 2N2, Canada; University of Toronto, 27 King's College Clr, Toronto, M5S 1A1, CanadaUniversity Health Network, 585 University Avenue, Toronto, M5G 2N2, Canada; University of Toronto, 27 King's College Clr, Toronto, M5S 1A1, CanadaUniversity Health Network, 585 University Avenue, Toronto, M5G 2N2, Canada; University of Toronto, 27 King's College Clr, Toronto, M5S 1A1, CanadaUniversity Health Network, 585 University Avenue, Toronto, M5G 2N2, Canada; University of Toronto, 27 King's College Clr, Toronto, M5S 1A1, CanadaUniversity Health Network, 585 University Avenue, Toronto, M5G 2N2, Canada; University of Toronto, 27 King's College Clr, Toronto, M5S 1A1, CanadaUniversity Health Network, 585 University Avenue, Toronto, M5G 2N2, Canada; University of Toronto, 27 King's College Clr, Toronto, M5S 1A1, CanadaUniversity Health Network, 585 University Avenue, Toronto, M5G 2N2, Canada; University of Toronto, 27 King's College Clr, Toronto, M5S 1A1, CanadaUniversity Health Network, 585 University Avenue, Toronto, M5G 2N2, Canada; University of Toronto, 27 King's College Clr, Toronto, M5S 1A1, CanadaUniversity Health Network, 585 University Avenue, Toronto, M5G 2N2, Canada; University of Toronto, 27 King's College Clr, Toronto, M5S 1A1, CanadaUniversity Health Network, 585 University Avenue, Toronto, M5G 2N2, Canada; University of Toronto, 27 King's College Clr, Toronto, M5S 1A1, CanadaUniversity Health Network, 585 University Avenue, Toronto, M5G 2N2, Canada; University of Toronto, 27 King's College Clr, Toronto, M5S 1A1, CanadaUniversity Health Network, 585 University Avenue, Toronto, M5G 2N2, Canada; University of Toronto, 27 King's College Clr, Toronto, M5S 1A1, CanadaUniversity Health Network, 585 University Avenue, Toronto, M5G 2N2, Canada; University of Toronto, 27 King's College Clr, Toronto, M5S 1A1, Canada; Toronto General Hospital Research Institute, 200 Elizabeth Street, Toronto, M5G 2C4, Canada; Corresponding author.Introduction and Objectives: Recurrent cirrhosis complicates 10-30% of Liver transplants (LT) and can lead to consideration for re-transplantation. We evaluated the trajectories of relisted versus primary listed patients on the waitlist using a competing risk framework. Materials and Methods: We retrospectively examined 1,912 patients listed for LT at our centre between from 2012 to 2020. Cox proportional hazard models were used to assess overall survival (OS) by listing type and competing risk analysis Fine-Gray models were used to assess cumulative incidence of transplant by listing type. Results: 1,731 patients were included (104 relisted). 44.2% of relisted patients received exception points vs. 19.8% of primary listed patients (p<0.001). Patients relisted without exceptions, representing those with graft cirrhosis, had the worst OS (HR: 4.17, 95%CI 2.63 – 6.67, p=<0.0001) and lowest instantaneous rate of transplant (HR: 0.56, 95%CI 0.38 – 0.83, p=0.006) than primary listed with exception points. On multivariate analysis listing type, height, bilirubin and INR were associated with cumulative incidence of transplant, while listing type, bilirubin, INR, sodium, creatinine were associated with OS. Within relisted patients, there was a trend towards higher mortality (HR: 1.79, 95%CI 0.91 – 3.52, p=0.08) and low transplant incidence (HR: 0.51, 95%CI 0.22 – 1.15, p=0.07) for graft cirrhosis vs other relisting indications. Conclusions: Patients relisted for LT are carefully curated and comprise a minority of the waitlist population. Despite their younger age, they have worse liver/kidney function, poor waitlist survival, and decreased transplant incidence suggesting the need for early relisting, while considering standardized exception points.http://www.sciencedirect.com/science/article/pii/S1665268123002715Re-transplantGraft cirrhosisGraft failureDonor allocationException pointsWaitlist outcomes |
| spellingShingle | Fakhar Ali Qazi Arisar Rhea Varghese Shiyi Chen Wei Xu Markus Selzner Ian McGilvray Blayne Sayed Trevor Reichman Chaya Shwaartz Mark Cattral Anand Ghanekar Gonzalo Sapisochin Elmar Jaeckel Cynthia Tsien Nazia Selzner Leslie Lilly Mamatha Bhat Trajectories of patients relisted for liver transplantation Annals of Hepatology Re-transplant Graft cirrhosis Graft failure Donor allocation Exception points Waitlist outcomes |
| title | Trajectories of patients relisted for liver transplantation |
| title_full | Trajectories of patients relisted for liver transplantation |
| title_fullStr | Trajectories of patients relisted for liver transplantation |
| title_full_unstemmed | Trajectories of patients relisted for liver transplantation |
| title_short | Trajectories of patients relisted for liver transplantation |
| title_sort | trajectories of patients relisted for liver transplantation |
| topic | Re-transplant Graft cirrhosis Graft failure Donor allocation Exception points Waitlist outcomes |
| url | http://www.sciencedirect.com/science/article/pii/S1665268123002715 |
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