Deaths on the liver transplant waiting list

An analysis of competing risks

W. Ray Kim, Terry M Therneau, Joanne T. Benson, Walter K Kremers, Charles B. Rosen, Gregory James Gores, E. Rolland Dickson

Research output: Contribution to journalArticle

97 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)345-351
Number of pages7
JournalHepatology
Volume43
Issue number2
DOIs
StatePublished - Feb 2006

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Waiting Lists
Transplants
Liver
Transplantation
Liver Diseases
End Stage Liver Disease
Hematologic Diseases
Liver Transplantation
Alcohols
Survival
Mortality

ASJC Scopus subject areas

  • Hepatology

Cite this

Deaths on the liver transplant waiting list : An analysis of competing risks. / Kim, W. Ray; Therneau, Terry M; Benson, Joanne T.; Kremers, Walter K; Rosen, Charles B.; Gores, Gregory James; Dickson, E. Rolland.

In: Hepatology, Vol. 43, No. 2, 02.2006, p. 345-351.

Research output: Contribution to journalArticle

Kim, W. Ray ; Therneau, Terry M ; Benson, Joanne T. ; Kremers, Walter K ; Rosen, Charles B. ; Gores, Gregory James ; Dickson, E. Rolland. / Deaths on the liver transplant waiting list : An analysis of competing risks. In: Hepatology. 2006 ; Vol. 43, No. 2. pp. 345-351.
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