The high-risk liver allograft recipient. Should allocation policy consider outcome?
F. L. Delmonico, R. L. Jenkins, R. Freeman, J. Vacanti, J. Bradley, J. L. Dienstag, C. Trey, W. D. Lewis, C. W. Lillehei, H. Auchincloss Jr and al. et
Boston (Mass) Center for Liver Transplantation.
The Boston Center for Liver Transplantation has accumulated one of the
larger series of liver allograft recipients. This review has provided an
opportunity to examine recent pronouncements by Medicare regarding patient
selection and survival and to question whether the current allocation
scheme best utilizes a scarce supply of donor liver allografts. Patients
with primary biliary cirrhosis, sclerosing cholangitis, and metabolic
derangements have enjoyed excellent survival: in aggregate, 78.9% at 1
year. In contrast, patients suffering from acute hepatic failure, patients
requiring life support, or patients with primary graft failure who need a
second liver transplant did poorly compared with other recipient groups:
45% 1-year survival. This center's experience reflects a more realistic
expectation of patient survival because it considers the high-risk
recipient by diagnosis and urgency status. This study also suggests that
assessment of outcome should be a component of allocation planning in the
future.
