Objective: Liver transplantation (LT) is a lifesaving treatment for end stage liver disease (ESLD). High acuity ESLD patients are disadvantaged as they are frequently denied by transplant centers due to the severity of illness. We analyzed outcomes after LT in high acuity patients using a specialized transplant critical care model (TCCM).

Methods: We analyzed data from our prospective database: 122 adults were listed with lab MELD≥35 or Status 1 from Jan. 2009 to Dec. 2016. Era 1 (prior to TCCM) was compared to Era 2 (TCCM established Oct. 1, 2012). Median follow up: 20 months.

Results: TCCM (Era 2) led to a significant increase in patients' access to LT and LT rate (Table & Fig 1). Frequency and need to seek LT at another center dropped 4 fold in Era 2. Most patients in Era 2 were in ICU prior to LT (83% vs. 25%, p<0.01) and on renal replacement therapy (67% vs. 13%, p<0.01). Despite higher acuity of illness in Era2, 1–year patient survival (Fig 2) was comparable (89% Era1, 80% Era 2, p=0.35).

Conclusion: Implementation of specialized transplant critical care model expanded LT access to high acuity patients, diminished seeking higher level of care elsewhere, and achieved excellent short-term post-transplant survival outcomes in critically ill patients.

CITATION INFORMATION: Selim M., Zimmerman M., Kim J., Pearson T., Eriksen C., Wong M., Boettcher B., Regner K., Saeian K., Woehlk H., Hong J. Specialized Transplant Critical Care Model Improves Access to Transplantation and Short-Term Survival Outcomes after Liver Transplantation in the Highest Acuity Patients Am J Transplant. 2017;17 (suppl 3).

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