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Open Access 01-12-2014 | Original Article

Outcome stagnation of liver transplantation for primary sclerosing cholangitis in the Model for End-Stage Liver Disease era

Authors: Johannes Klose, Michelle A. Klose, Courtney Metz, Frank Lehner, Michael P. Manns, Juergen Klempnauer, Nils Hoppe, Harald Schrem, Alexander Kaltenborn

Published in: Langenbeck's Archives of Surgery | Issue 8/2014

Abstract

Purpose

Survival after liver transplantation (LTX) has decreased in Germany since the implementation of Model for end-stage liver disease (MELD)-based liver allocation. Primary sclerosing cholangitis (PSC) is known for its otherwise excellent outcome after LTX. The influence of MELD-based liver allocation and subsequent allocation policy alterations on the outcome of LTX for PSC is analyzed.

Methods

This is a retrospective observational study including 126 consecutive patients treated with LTX for PSC between January 1, 1999 and August 31, 2012. The PSC cohort was further compared to all other indications for LTX in the study period (n = 1420) with a mean follow-up of 7.9 years (SD 3.2). Multivariate risk-adjusted analyses were performed. Alterations of allocation policy have been taken into account systematically.

Results

Transplant recipients suffering from PSC are significantly younger (p < 0.001), can be discharged earlier (p = 0.018), and have lower 3-month mortality than patients with other indications (p = 0.044). The observed time on the waiting list is significantly longer for patients with PSC (p < 0.001), and there is a trend toward lower match MELD points in the PSC cohort (p = 0.052). No improvement in means of short-term mortality could be shown in relation to alterations of allocation policy within the MELD era (p = 0.375). Survival rates of the pre-MELD era did not differ significantly from those of the MELD era (p = 0.097) in multivariate risk-adjusted analysis. Patients in the MELD era suffered pre-transplant significantly more frequently from dominant bile duct stenosis (p = 0.071, p = 0.059, p = 0.048, respectively; chi²).

Conclusions

Progress is stagnating in LTX for PSC. Current liver allocation for PSC patients should be reconsidered.

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Title: Outcome stagnation of liver transplantation for primary sclerosing cholangitis in the Model for End-Stage Liver Disease era
Authors: Johannes Klose
Michelle A. Klose
Courtney Metz
Frank Lehner
Michael P. Manns
Juergen Klempnauer
Nils Hoppe
Harald Schrem
Alexander Kaltenborn
Publication date: 01-12-2014
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 8/2014
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-014-1214-6

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Outcome stagnation of liver transplantation for primary sclerosing cholangitis in the Model for End-Stage Liver Disease era

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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