Deaths on the liver transplant waiting list: An analysis of competing risks.

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Hepatology.

2006 Feb;43(2):345-51.

Deaths

on the liver transplant waiting list: An analysis of competing risks.

Kim

WR, Therneau

TM, Benson

JT, Kremers

WK, Rosen

CB, Gores

GJ, Dickson

ER.

Division of Gastroenterology and Hepatology, Mayo Clinic College of

Medicine, Rochester, MN.

The usual method of estimating survival probabilities, namely the Kaplan-Meier

method, is suboptimal in the analysis of deaths on the transplant waiting list.

Death, transplantation, and withdrawal from list must all be considered. In

this analysis, we applied the competing risk analysis method, which allows

evaluating these end points individually and simultaneously, to compare the

risk of waiting list death across era, blood types, liver disease diagnosis,

and severity (Model for End-stage Liver Disease; MELD). Of 861 patients

registered on the waiting list at Mayo Clinic Rochester between 1990 and 1999,

657 (76%) patients underwent transplantation, 82 (10%) died while waiting, 41

(5%) withdrew from the list, and 81 (9%) patients were still waiting as of

February 2002. The risk of death at 3 years was 10% by the competing risk

analysis. During the study period, the median time to transplantation increased

from 45 to 517 days. In univariate analyses, there

was no significant difference in the risk of death by era of listing (P = .25)

or blood type (P = .31), whereas the risk of death was significantly higher in

patients with alcohol-induced liver disease and those with higher MELD score (P

< .01). A multivariable analysis showed that after adjusting for MELD, blood

type, and diagnosis, patients listed in the latter era had higher mortality. In

conclusion, the competing risk analysis method is useful in estimating the risk

of death among patients awaiting liver transplantation. (HEPATOLOGY 2006;43:345-351.).

PMID: 16440361 [PubMed - in process]

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