Liver transplant (LT) has revolutionized the management of end-stage liver disease in the past 2 decades. The institution of the Model for End-Stage Liver Disease scoring system for organ allocation has de-emphasized recipient waiting time, but its effect on patients' referral to liver transplant centers is unclear. The aim of this retrospective study was to analyze the outcome of patients referred for liver transplant in a 12-month period (January 1, 2005, through December 31, 2005) after the institution of the new scoring system. During the study period, 555 patients were presented 605 times to the Liver Transplant Selection Committee. Of the 295 patients initially denied LT, 150 patients (51%) were denied because they were considered too early, 29 (10%) because their tumor did not meet institutional criteria, 72 (24%) because of concomitant psychosocial issues, and 44 (15%) because of comorbid conditions. Patients considered too early and those with psychosocial reasons for denial were often re-presented and listed for LT. Our findings suggest that patients could benefit from early referral to an LT center, even if they are initially denied listing, because management of end-stage renal disease could be initiated and psychosocial issues could be addressed. Referring physicians and transplant centers need to develop a strategy to ensure optimal timing of referrals for LT.
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