Impact of allocation policy on waitlist outcomes for liver transplant candidates with transjugular intrahepatic portosystemic shunt (tips)

Document Type

Conference Proceeding

Publication Date

10-1-2021

Publication Title

Hepatology

Abstract

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective treatment of refractory ascites and variceal bleeding. It is reported that patients who receive TIPS prior to listing have a lower chance for transplantation compared to patients without TIPS. It is not clear whether the new liver transplant (LT) allocation policy, acuity circle (AC)-based model, has improved the chances of LT for patients with TIPS. This study aims to determine the impact of various allocation policies on the waitlist outcomes for patients with TIPS. Methods: Using the United Network for Organ Sharing (UNOS) registry, 115,634 adult candidates listed between January 1st, 2010, and March 5th, 2021, were evaluated and patients who underwent TIPS prior to listing were included (n= 9,368). Patients listed as multi-organ transplant, and re-transplant were excluded. Three periods were defined according to the listing date: MELD era (Jan 1st, 2010, to Jan 9th, 2016; n=4,703), MELD-Na era (Jan 11th, 2016, to Feb 2nd, 2020; n=3,766) and post-AC era (Feb 4th, 2020, to Mar 5th, 2021; n= 896). Patients were censored on the last day of each period. Waitlist outcomes were compared between the groups using Gray test, and Fine-Gray hazard regression models while adjusting for baseline patient characteristics at listing Results: Compared to previous allocation policies, LT candidates with TIPS listed in the AC era had a higher median MELD score (AC 17; MELD-Na 17; MELD 16; p<0.001), larger proportion of moderate ascites (AC 30.6%; MELD-Na 28.3%; MELD 25.5%; p<0.001) and grade 3-4 encephalopathy (AC 11.2%; MELD-Na 9.9%; MELD 7.7%; p<0.001). When compared to the AC era, the 90-day waitlist mortality of patients listed with TIPS was higher during the MELD era (aHR 1.75; 95% CI 1.26-2.42; p<0.001) but similar during the MELD-Na era (aHR 1.10; 95% CI 0.78-1.53; p=0.52; Figure 1A). LT candidates with TIPS prior to listing had a lower 90-day transplant probability in both MELD-Na era (aHR 0.72; 95% CI 0.61-0.84; p<0.001) and MELD era (aHR 0.58; 95% CI 0.49-0.68; p<0.001) compared to the AC era (Figure 1B). When comparing the 90-day transplant probability for patients listed with TIPS vs. no TIPS for each allocation policy era, patients with TIPS had a lower chance for transplant in the MELD (aHR 0.89; 95% CI 0.83-0.96; p=0.002) and MELD-Na (aHR 0.90; 95% CI 0.84-0.96; p=0.002) eras, but a similar chance of transplant in the post-AC era (aHR 0.94; 95% CI 0.83-1.06; p=0.07; Figure 1C). Conclusion: The transplant probability of patients with TIPS was significantly better during the AC era compared to previous eras. This is potentially due to increased national sharing of organs offering patients with TIPS access to more donors. .

Volume

74

Issue

SUPPL 1

First Page

848A

Last Page

849A

Find It @ Sladen

Share

COinS