SEVERITY OF ILLNESS AMONG LONG WAITING LIVER TRANSPLANT CANDIDATES IN AN ORGAN POOR REGION

Abstract

277 Active listing of patients with endstage liver disease (ESLD) earlier than was previously felt appropriate seems medically necessary to transplant physicians and savvy patients due to rising waiting times (WT). Yet, examination of national practices reveals wide disparities in WT to liver transplantation. Some have suggested that regions with relatively long WT have "padded" waiting lists with ESLD patients who are relatively healthier than those in regions with shorter WT. They imply that using "artificially elevated" WT to assess regional access to organs is therefore misleading. Since our center is located within a region with notoriously long WT, we reassessed the severity of illness among all 88 of our patients awaiting liver transplantation using UNOS defined criteria. Records were reviewed to confirm prior histories. Referring physicians were consulted when necessary to provide current laboratory values (<4 months from 1/1/98). Assignment to status categories reflects new UNOS definitions.TableNew UNOS Status of Patients Awaiting Liver TransplantationReview of our liver transplant waiting list revealed 7/88 dead patients;8%. One patient was lost to follow-up and 1 was transplanted elsewhere. Thus the severity of illness of 79 living patients awaiting transplantation was reviewed. 34/79 (43%) met new UNOS criteria for severe chronic illness. 33/79(42%) met new UNOS minimal listing criteria (MLC). 4/79 patients did not meet stipulated MLC; 2 biliary necrosis 20 hepatic artery thrombosis, 1 hemophilia A + hepatitis C, 1 PBC; appeals will be made to the Regional Review Board on behalf of the first 3. Of 20 previously inactive patients (status 7), 12 (60%) meet MLC for status 3, 7 (35%) don't meet MLC, and 1 (5%) is too sick to transplant. We conclude that 49% (7 dead + 34-2B + 1 too sick) of patients awaiting liver transplantation have died or have severe chronic ESLD. An additional 42% meet MLC. Only 7/88 (8%) have recovered or are not sufficiently ill to justify transplantation. Long WT is not associated with medically unnecessary, premature listing for liver transplantation.