Background. The Model for End-stage Liver Disease (MELD) score is a good discriminator of 3-month mortality in patients awaiting a liver transplant. Previous research showed no demonstrated net transplant benefit for scores < 15, leading to the OPTN's “Share 15" liver distribution policies; however death and transplant occur in those with scores < 15. We identified factors associated with death vs transplant in low-MELD patients. Methods. Adult candidates with final/current MELD lab scores of 6-14 removed from the list for transplant, death, or other reasons from 7/1/12-11/25/16 (or were still waiting) were included if MELD laboratory data were entered within 30 days prior to removal. Deaths were defined as removed for death, or for “too sick” or “other” but with death reported within 30 days after removal. Status 1A/1Bs were excluded. Competing risks regression was used to determine factors associated with death vs. transplant. Results. Of 9323 patients meeting inclusion criteria, 1015 (10.9%) died, 5290 (56.7%) were transplanted (353 living donor txs), 1523 (16.3%) removed for other reason, and 1495 (16.0%) were still waiting. Encephalopathy, Black ethnicity, diagnosis indicating alcohol use or cirrhosis, and age were associated with an increased hazard of death. HCC exception, moderate ascites, waiting for another organ, previous abdominal surgery or malignancy, and male gender were associated with increased hazard of transplant.

History of TIPPS, portal vein thrombosis, and bacterial peritonitis were not found to be significant. Discussion. In this sample, patients with encephalopathy were at highest risk for death (HR 1.6), while those with HCC exceptions were much more likely to receive a transplant (HR 4.1). Identification of those at risk for waitlist mortality and further analysis of the causes of waiting list death may allow for improved prioritization of patients waiting for a liver transplant.

CITATION INFORMATION: Harper A, Edwards E, Heimbach J. Factors Associated with Death or Transplant in Low-MELD Patients. Am J Transplant. 2017;17 (suppl 3).

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