Published online Apr 27, 2019. doi: 10.4254/wjh.v11.i4.370
Peer-review started: February 13, 2019
First decision: March 14, 2019
Revised: March 21, 2019
Accepted: April 8, 2019
Article in press: April 8, 2019
Published online: April 27, 2019
Patients with cirrhosis deemed ineligible for liver transplantation are usually followed in general hepatology or gastroenterology clinics, with the hope of re-evaluation once they meet the appropriate criteria. Specific strategies to achieve liver transplant eligibility for these patients have not been studied.
To assess clinical and sociodemographic factors associated with future liver transplant eligibility among patients initially considered ineligible.
This is a retrospective study of patients with cirrhosis considered non-transplant eligible, but without absolute contraindications, who were scheduled in our transitional care liver clinic (TCLC) after discharge from an inpatient liver service. Transplant candidacy was assessed 1 year after the first scheduled TCLC visit. Data on clinical and sociodemographic factors were collected.
Sixty-nine patients were identified and the vast majority were Caucasian men with alcoholic cirrhosis. 46 patients (67%) presented to the first TCLC visit. Seven of 46 patients that showed to the first TCLC visit became transplant candidates, while 0 of 23 patients that no-showed did (15.2% vs 0%, P = 0.08). Six of 7 patients who showed and became transplant eligible were accompanied by family or friends at the first TCLC appointment, compared to 13 of 39 patients who showed and did not become transplant eligible (85.7% vs 33.3%, P = 0.01).
Patients who attended the first post-discharge TCLC appointment had a trend for higher liver transplant eligibility at 1 year. Being accompanied by family or friends during the first TCLC visit correlated with higher liver transplant eligibility at 1 year (attendance by family or friends was not requested). Patient and family engagement in the immediate post-hospitalization period may predict future liver transplant eligibility for patients previously declined.
Core tip: Being declined as a liver transplant candidate is not always an irreversible decision, but there is limited information about predictors for eventually achieving liver transplant eligibility. This study shows that among patients who were found not to be transplant candidates, those who presented to their post hospital discharge liver clinic appointment with family and friends had a higher chance of liver transplant eligibility within one year. This finding suggests the importance of engaging family and friends in the complex care of patients with cirrhosis.