The Survival Benefit of Deceased Donor Liver Transplantation as a Function of Candidate Disease Severity and Donor Quality

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To cite this article: D. E. Schaubel, C. S. Sima, N. P. Goodrich, S. Feng, R. M. Merion (2008) The Survival Benefit of Deceased Donor Liver Transplantation as a Function of Candidate Disease Severity and Donor Quality American Journal of Transplantation 8 (2), 419–425. doi:10.1111/j.1600-6143.2007.02086.x

Abstract

The Survival Benefit of Deceased Donor Liver Transplantation as a Function of Candidate Disease Severity and Donor Quality

D. E. Schaubela,baDepartment of Biostatistics, University of Michigan, Ann Arbor, MIbScientific Registry for Transplant Recipients, Ann Arbor, MI, C. S. Simab,cbScientific Registry for Transplant Recipients, Ann Arbor, MIcArbor Research Collaborative for Health, Ann Arbor, MI, N. P. Goodrichb,cbScientific Registry for Transplant Recipients, Ann Arbor, MIcArbor Research Collaborative for Health, Ann Arbor, MI, S. FengddDepartment of Surgery, University of California, San Francisco, CA and R. M. Merionb,ebScientific Registry for Transplant Recipients, Ann Arbor, MIeDepartment of Surgery, University of Michigan, Ann Arbor, MI

aDepartment of Biostatistics, University of Michigan, Ann Arbor, MI bScientific Registry for Transplant Recipients, Ann Arbor, MI cArbor Research Collaborative for Health, Ann Arbor, MI dDepartment of Surgery, University of California, San Francisco, CA eDepartment of Surgery, University of Michigan, Ann Arbor, MI

*Corresponding author: D.E. Schaubel, deschau@...

Abstract

The survival benefit of liver transplantation depends on candidate disease severity, as measured by MELD score. However, donor liver quality may also affect survival benefit. Using US data from the SRTR on 28 165 adult liver transplant candidates wait-listed between 2001 and 2005, we estimated survival benefit according to cross-classifications of candidate MELD score and deceased donor risk index (DRI) using sequential stratification. Covariate-adjusted hazard ratios (HR) were calculated for each liver transplant recipient at a given MELD with an organ of a given DRI, comparing posttransplant mortality to continued wait-listing with possible later transplantation using a lower-DRI organ. High-DRI organs were more often transplanted into lower-MELD recipients and vice versa. Compared to waiting for a lower-DRI organ, the lowest-MELD category recipients (MELD 6–8) who received high-DRI organs experienced significantly higher mortality (HR = 3.70; p < 0.0005). All recipients with MELD ≥20 had a significant survival benefit from transplantation, regardless of DRI. Transplantation of high-DRI organs is effective for high but not low-MELD candidates. Pairing of high-DRI livers with lower-MELD candidates fails to maximize survival benefit and may deny lifesaving organs to high-MELD candidates who are at high risk of death without transplantation.