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Waiting longer for a liver transplant increases the risk of graft failure following transplantation

Individuals with the most urgent need for a liver transplant are currently placed at the top of regional lists by the United Network for Organ Sharing. Patients expected to live less than 7 days without a transplant are considered status 1, those hospitalized for at least 5 days are status 2, and those at home or hospitalized less than 5 days are status 3. Current proposals would eliminate regional preferences in favor of a national organ allocation waiting list. The result would be an increased number of organs allocated to status 1 and 2 patients and an increase of about 1 year in waiting time for status 3 patients.

This longer waiting time before a liver transplant would increase graft failure rates among these healthier patients, according to a study supported by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00055). However, this concern must be weighed against the lower pretransplant mortality rate of status 1 patients under a national organ allocation system, explains David Howard, Ph.D., of Emory University.

Dr. Howard used blood type as a marker for transplant waiting time, with people who have type O blood (compatible only with type O donors) having the longest waiting times for organs and those with type AB blood (who can receive livers from any donor) having the shortest. He calculated the impact of waiting time on the probability of graft failure in 9,250 patients with liver failure who underwent a first liver transplant between 1995 and 1997.

A 50-day increase in waiting time increased graft failure rates at 1 year by 1.6 percentage points in the entire sample. The mean waiting time for a transplant was 192 days, with a standard deviation of 222 days. Type O patients, who waited an average of 52 days longer than type A patients, had a 25 percent greater probability of graft failure within 3 months than type A patients (15 vs. 12 percent).

More details are in "The impact of waiting time on liver transplant outcomes," by Dr. Howard, in the December 2000 Health Services Research 35(5), pp. 1117-1134.

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