Fewer patients with primary sclerosing cholangitis die while awaiting liver transplants than those with other liver diseases
Research Activities, August 2012, No. 384
Liver transplant is the only real, lasting cure for patients suffering from primary sclerosing cholangitis (PSC), a progressive and sometimes fatal disease. Normal liver transplant criteria (the Model for End-state Liver Disease [MELD] score) may not be well-suited for these patients, owing to their increased risk for developing biliary cancer and other complications. In a new study, researchers examined the risk of waitlist removal for death or clinical deterioration of these patients, compared to those with other forms of end-stage liver disease. They found that the risk of death or waitlist removal was lower for these patients than patients with other forms of end-stage liver diseases.
Patients listed for liver transplant were identified from the United Network for Organ Sharing/Organ Procurement and Transplantation Network database. A total of 71,976 patients met the inclusion criteria. Of these, 4.4 percent had PSC. Patients with PSC were more likely to be younger, white males with insurance.
A significantly greater proportion of patients without PSC died or were removed from the waitlist as a result of clinical deterioration (20.5 percent) compared to patients with PSC (13.6 percent). PSC patients who died or were removed from the donor list experienced significantly greater wait times before list removal compared to non-PSC patients. However, non-PSC patients also more commonly experienced complications from portal hypertension. MELD scores were similar for both groups of patients at the time of death or waitlist removal. The lower risk of death or waitlist removal in patients with PSC remained reduced even after adjustments were made for MELD scores, complications of portal hypertension, and other factors.
Given these findings, the researchers see no reason for changing MELD scoring methods in order to promote greater access to liver transplants among patients with PSC. The study was supported in part by the Agency for Healthcare Research and Quality (HS18406).
See "Waitlist survival of patients with primary sclerosing cholangitis in the model for end-stage liver disease era," by David Goldberg, M.D., Benjamin French, Ph.D., Arwin Thomasson, M.S., and others in Liver Transplantation 17(11), pp. 1355-1363, 2011.