Demand for liver transplantation continues to exceed donor organ supply.
Comparing recipient survival to that of comparable candidates without a transplant can improve understanding of transplant survival benefit.
Dr Meriona and colleagues from Michigan, America undertook a study of waiting list and post-transplant mortality among a cohort of 12, 996 adult patients who had been placed on the waiting list between 2001 and 2003.
The investigators used time-dependent Cox regression models to determine relative mortality rates for candidates and recipients.
The researchers found that overall, deceased donor transplant recipients had a 79% lower mortality risk than candidates.
| Survival benefit increased with increasing MELD score|
|American Journal of Transplantation|
In addition, the research team found that at Model for End-stage Liver Disease (MELD) 1820, mortality risk was 38% lower among recipients compared to candidates.
Survival benefit increased with increasing MELD score; at the maximum score of 40, recipient mortality risk was 96% lower than that for candidates.
In contrast, the researchers found that at lower MELD scores, recipient mortality risk during the first post-transplant year was much higher than for candidates.
Dr Meriona concluded, "Liver transplant survival benefit at 1 year is concentrated among patients at higher risk of pre-transplant death."
"Futile transplants among severely ill patients are not identified under current practice."
"With 1 year post-transplant follow-up, patients at lower risk of pre-transplant death do not have a demonstrable survival benefit from liver transplant."