Identifying a clinically relevant cutoff for height that is associated with a higher risk of waitlist mortality in liver transplant candidates.

Abstract

Height explains a substantial proportion of gender-based disparity in waitlist mortality among liver transplant candidates. We sought to identify a clinically relevant height cutoff below which waitlist mortality increases significantly. We examined all nonstatus one adult liver transplant candidates from 2010 to 2014. We used a recursive application of the minimum P value approach with univariate competing risk regressions (deceased donor liver transplantation as the competing risk) to detect differences in waitlist mortality with regards to height. Of 69883 candidates, 36% (24819) were women and 64% (45064) were men. Median height for all was 173cm: 163cm in women, 178cm in men. The optimal search method of recursively evaluating smaller height intervals yielded 166cm as the optimal height cutoff. Using height <166cm as the cutoff, 72% of women and 9% of men met criteria. Compared to candidates ≥166cm, "short stature" candidates had higher rates of death/delisting (28% vs 24%) and lower rates of transplantation (38% vs 44%) (P<.01 for both). After adjustment for clinical and demographic characteristics, height <166cm remained associated with an 8% increased risk of waitlist mortality (95% CI 1.03-1.14, P<.01). Short candidate height may be a motivation to explore split livers or living donors as accelerated liver transplantation options.