End-stage liver disease patients with MELD >40 have higher waitlist mortality compared to Status 1A patients.

Abstract

Status 1A patients are prioritized over end-stage liver disease (ESLD) for liver transplantation (LT). ESLD patients with high MELD may have higher waitlist mortality than Status 1A patients, and may require LT more urgently. Using United Network for Organ Sharing registry data, we retrospectively evaluated LT waitlist mortality and probability of LT between adults in the United States with Status 1A or ESLD with MELD >30 listed for LT from 2003-2013. Overall waitlist mortality and probability of LT were evaluated with Kaplan-Meier and multivariate logistic regression models. From 2003-2013, 15,049 ESLD patients with MELD >30 and 3049 Status 1A patients were listed for LT. While overall 14-day waitlist survival decreased with increasing MELD score among ESLD patients (54.0% for MELD 31-35; 37.1% for MELD 36-40; 27.5% for MELD >40), overall survival at 14days was significantly lower among Status 1A (14.4%). Compared to Status 1A, ESLD patients with MELD >40 had significantly higher 14-day waitlist mortality (OR 1.92; 95% CI 1.56-2.36; p<0.001), whereas ESLD patients with MELD 36-40 had a non-significant trend towards higher waitlist mortality (OR 1.16; 95% CI 0.93-1.45; p=0.181). No difference in probability of LT within 14 days was observed between ESLD with MELD >40 and Status 1A (p=0.89). ESLD patients with MELD >40 had higher post-LT survival compared to Status 1A on multivariate regression modeling (HR 0.80; 95% CI 0.66-0.96; p<0.02). Among adults in the United States awaiting LT, ESLD patients with MELD >40 have significantly higher waitlist mortality, but similar probability of receiving LT compared to Status 1A patients.