Researchers analyzed 43,497 patients on the UNOS waitlist for a liver transplantation and 22,863 adults who received transplantation to determine the best time strategy for transplantation. They concluded that the increase in posttransplant mortality caused by differences in donor type was vastly offset by the greater benefit in early access to transplantation regardless of donor type. According to Michael Goldstein, MD, principal investigator, "The study might affect thousands of patients since it may change the way in which we allocate organs."

UNOS uses the Mayo Model for End-Stage Liver Disease (MELD) score, a marker of disease severity to assess prognosis of patients with liver disease. According to Dr. Goldstein, "Percentage of patients who are on the transplant list who die before transplant varies by region but we estimate between 5% and 10%." Patients are usually added to the waitlist when they meet certain medical criteria for transplantation. MELD scores may vary at the time of listing, depending on the severity of illness and the timing of presentation to a transplant center. "Many other patients will not meet criteria for listing because of severity of disease and some will become inactive and die because of progression of cancer or unstable psychosocial situations," says Dr. Goldstein.

The researchers calculated the relative waitlist mortality and posttransplant survival for recipients who received living donor organs, as well as deceased donor organs that are both low and high donor risk index. They concluded that living donor and high donor risk index allografts offer the most benefit to those with a mid-Meld score (between 11 and 24) but is dependent on early timing of transplant and should be used early to decrease waitlist mortality. Speaking of the conclusions, Dr. Goldstein says, "We are not surprised by the findings. We have assumed this for some time in New York and live by these standards every day."

Dr. Goldstein concludes, "The real benefits to adopting new allocation strategies are to increase regional organ sharing for those areas most disadvantaged by the donor shortage. We can redistribute organs from areas with short waiting times to allow sick patients to be transplanted sooner in regions with little access to organs."

Abstract title:

Early access to liver transplantation reduces 5-year mortality despite differences in donor quality

AASLD is the leading medical organization for advancing the science and practice of hepatology. Founded by physicians in 1950, AASLD's vision is to prevent and cure liver diseases. This year's Liver Meeting, held in San Francisco, California, October 31-November 4, will bring together more than 7,000 researchers from 55 countries.

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