Early evaluation reduces pre-liver transplant mortality

Evaluating patients within 30 days of referral for liver transplantation reduces pre-procedure mortality, according to research presented at The Liver Meeting Digital Experience.

In his presentation, Binu V. John, MD, from Miami VA Medical Center, said there is a lot of variability of access to liver transplantation as well as how quickly patients are evaluated after referral.

“The impact of time from referral to initial evaluation at a liver transplant center and its effect on outcomes is unknown,” he said. “There’s limited published data on the outcomes of ‘all comers’ referred for transplantation.”

Researchers analyzed data from 1,118 patients who underwent evaluation for liver transplantation. In the overall group, 832 patients underwent evaluation within 30 days of referral, and 286 patients underwent evaluation more than 30 days after referral.

Investigators explored the effects on time to be placed on the waitlist, time to transplantation and pre- and post-transplant mortality.

John and colleagues found that patients in the early referral group had a shorter adjusted time from referral to listing by 29.5 days and shorter time from referral to transplantation by 115.1 days.

After adjusting for potential confounders, researchers found that evaluation within 30 days of referral was associated with lower pre-transplant mortality (adjusted HR = 0.68; 95% CI, 0.5-0.9).

Additionally, John and colleagues found that age (aHR = 1.03; 95% CI, 1-1.04), female sex (aHR = 1.87; 95% CI, 1-3.4), race or ethnicity other than white, Black, or Hispanic (aHR = 3.66; 95% CI, 2.1-6.6), diabetes (aHR = 1.64; 95% CI 1.5-1.8), and MELD score (aHR = 1.03; 95% CI, 1-1.1) were associated with higher pre-transplant mortality.

“Our data suggest that improving transplant hepatologist access to less than 30 days is associated with improved outcomes,” John said.