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
There is minimal data on the long-term outcomes of patients with cirrhosis who are declined for liver transplantation. Many of these ineligible patients are followed by general hepatology and gastroenterology providers with the hope of re-eligibility for transplantation. Specific strategies to achieve liver transplant eligibility for these patients have not been studied.
We were motivated to pursue this project so that the field may have a better understanding of the clinical and sociodemographic factors that may predict future liver transplant eligibility for those initially considered ineligible.
The objective of our study was to assess clinical and sociodemographic factors associated with one-year liver transplant eligibility among patients with cirrhosis seen in a transitional care liver clinic who were considered unsuitable transplant candidates but did not have absolute contraindications.
Retrospective, single-center study.
69 patients were identified, predominantly Caucasian men with alcoholic cirrhosis. 46 patients (67%) presented to the first TCLC visit. Seven of 46 patients that presented to the first TCLC visit became transplant candidates at one year, 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 ineligible for liver transplantation, but without absolute contraindications, who presented to our TCLC were more likely to be listed for liver transplantation at one year if they were joined by family or friends at the first clinic visit. While more research is needed, patient and family participation in clinical care may serve as a surrogate marker of social support for patients previously declined for liver transplant.
This study reinforced the importance of investigating the long-term outcomes of patients with cirrhosis who are declined for liver transplantation. Given our small study population and known variations in transplant listing policies at each institution, larger multi-centered prospective studies are needed.