Outcome stagnation of liver transplantation for primary sclerosing cholangitis in the Model for End-Stage Liver Disease era
Creators: name: Klose, Johannes
name: Klose, Michelle A.
name: Metz, Courtney
name: Lehner, Frank
name: Manns, Michael P.
name: Klempnauer, Jürgen
name: Hoppe, Nils
name: Schrem, Harald
name: Kaltenborn, Alexander
Publisher: name: Heidelberg : Springer Verlag
Year: 2014
Subjects: subject: Autoimmune liver disease
subject: Cholangiocarcinoma
subject: MELD-based allocation
subject: Multivariate analysis
subject: Outcome
subject: Survival
subject: adolescent
subject: adult
subject: age distribution
subject: Article
subject: child
subject: cholestasis
subject: controlled study
subject: female
subject: follow up
subject: Germany
subject: graft recipient
subject: health care policy
subject: hospital admission
subject: hospital discharge
subject: human
subject: liver transplantation
subject: male
subject: Model For End Stage Liver Disease Score
subject: mortality
subject: multivariate analysis
subject: observational study
subject: outcome assessment
subject: primary sclerosing cholangitis
subject: resource allocation
subject: retrospective study
subject: risk assessment
subject: survival rate
subject: treatment indication
subject: aged
subject: Cholangitis, Sclerosing
subject: end stage liver disease
subject: epidemiology
subject: length of stay
subject: middle aged
subject: operation duration
subject: postoperative complication
subject: preschool child
subject: statistics and numerical data
subject: treatment outcome
subject: Adolescent
subject: Adult
subject: Aged
subject: Child
subject: Child, Preschool
subject: End Stage Liver Disease
subject: Female
subject: Health Policy
subject: Humans
subject: Length of Stay
subject: Liver Transplantation
subject: Male
subject: Middle Aged
subject: Operative Time
subject: Postoperative Complications
subject: Retrospective Studies
subject: Risk Assessment
subject: Survival Rate
subject: Treatment Outcome
subject: Waiting Lists
subject: Dewey Decimal Classification::600 | Technik::610 | Medizin, Gesundheit

description: Purpose: Survival after liver transplantation (LTX) has decreased in Germany since the implementation of Model for end-stage liver disease (MELD)-based liver allocation. Primary sclerosing cholangitis (PSC) is known for its otherwise excellent outcome after LTX. The influence of MELD-based liver allocation and subsequent allocation policy alterations on the outcome of LTX for PSC is analyzed.Methods: This is a retrospective observational study including 126 consecutive patients treated with LTX for PSC between January 1, 1999 and August 31, 2012. The PSC cohort was further compared to all other indications for LTX in the study period (n = 1420) with a mean follow-up of 7.9 years (SD 3.2). Multivariate risk-adjusted analyses were performed. Alterations of allocation policy have been taken into account systematically.Results: Transplant recipients suffering from PSC are significantly younger (p &lt; 0.001), can be discharged earlier (p = 0.018), and have lower 3-month mortality than patients with other indications (p = 0.044). The observed time on the waiting list is significantly longer for patients with PSC (p &lt; 0.001), and there is a trend toward lower match MELD points in the PSC cohort (p = 0.052). No improvement in means of short-term mortality could be shown in relation to alterations of allocation policy within the MELD era (p = 0.375). Survival rates of the pre-MELD era did not differ significantly from those of the MELD era (p = 0.097) in multivariate risk-adjusted analysis. Patients in the MELD era suffered pre-transplant significantly more frequently from dominant bile duct stenosis (p = 0.071, p = 0.059, p = 0.048, respectively; chi2).Conclusions: Progress is stagnating in LTX for PSC. Current liver allocation for PSC patients should be reconsidered.