Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2011 May 27;91(10):1148-52.
doi: 10.1097/TP.0b013e31821694b3.

Current trends in living donor liver transplantation for primary sclerosing cholangitis

David Seth Goldberg  1 , Benjamin French, Arwin Thomasson, K Rajender Reddy, Scott D Halpern
Affiliations

Current trends in living donor liver transplantation for primary sclerosing cholangitis

David Seth Goldberg et al. Transplantation. .

Abstract

Background: Use of the Model for End-Stage Liver Disease (MELD) score has improved the efficiency of allocating deceased donor organs for liver transplant. However, its use may reduce access to deceased donor livers for patients with primary sclerosing cholangitis (PSC) due to the weighting of the MELD score variables. To overcome such barriers in the post-MELD era, clinicians might refer patients with PSC, relative to patients without PSC, for living donor transplants more frequently.

Methods: To test this hypothesis, we examined patients in the United Network for Organ Sharing database from December 1, 1994, to May 31, 2009.

Results: In multivariable models conditioned on transplant center, patients with PSC were significantly more likely to receive a living donor transplant in both the pre-MELD (odds ratio [OR]=2.75; 95% confidence interval [CI], 2.20-3.44) and post-MELD eras (OR=4.08; 95% CI, 3.45-4.82). There was a significant interaction between PSC and post-MELD era of transplantation (OR=1.48; 95% CI, 1.11-1.97), indicating that patients with PSC were more likely to receive living donor transplants at baseline relative to patients without PSC, and that this effect was magnified following the introduction of the MELD score.

Conclusions: These findings raise the possibility that allocating livers on the basis of MELD score may have yielded the unintended consequence of increasing rates for living donor transplants for patients with PSC relative to patients with other forms of end-stage liver disease. Future research is needed to determine whether the practice of selectively transplanting patients with PSC with living donor transplants is associated with differences in clinical outcomes.

PubMed Disclaimer

Conflict of interest statement

Disclosure

The authors of this manuscript have no conflicts of interest to disclose as described by the journal Transplantation.

Figures

Figure 1
Figure 1
Wait time prior 10 transplantation for liver-transplant recipients, based on year of listing, for PSC and non-PSC patients. The symbol ‘■’ indicates the median wait time; solid lines indicate the inter-quartile range.
See this image and copyright information in PMC

References

    1. Bambha K, Kim WR, Talwalkar J, Torgerson H, Benson JT, Therneau TM, et al. Incidence, clinical spectrum, and outcomes of primary sclerosing cholangitis in a United States community. Gastroenterology. 2003 Nov;125(5):1364–9. - PubMed
    1. Roberts MS, Angus DC, Bryce CL, Valenta Z, Weissfeld L. Survival after liver transplantation in the United States: a disease-specific analysis of the UNOS database. Liver Transpl. 2004 Jul;10(7):886–97. - PubMed
    1. Aadland E, Schrumpf E, Fausa O, Elgjo K, Heilo A, Aakhus T, et al. Primary sclerosing cholangitis: a long-term follow-up study. Scand J Gastroenterol. 1987 Aug;22(6):655–64. - PubMed
    1. Bergquist A, Ekbom A, Olsson R, Kornfeldt D, Loof L, Danielsson A, et al. Hepatic and extrahepatic malignancies in primary sclerosing cholangitis. J Hepatol. 2002 Mar;36(3):321–7. - PubMed
    1. Broome U, Lofberg R, Veress B, Eriksson LS. Primary sclerosing cholangitis and ulcerative colitis: evidence for increased neoplastic potential. Hepatology. 1995 Nov;22(5):1404–8. - PubMed

Publication types