Inactive status is an independent predictor of liver transplant waitlist mortality and is associated with a transplant centers median meld at transplant

<h4>Background</h4> Approximately 30% of patients on the liver transplant waitlist experience at least one inactive status change which makes them temporarily ineligible to receive a deceased donor transplant. We hypothesized that inactive status would be associated with higher mortality...

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Autores principales:	Jonathan Merola, Geliang Gan, Darren Stewart, Samantha Noreen, David Mulligan, Ramesh Batra, Danielle Haakinson, Yanhong Deng, Sanjay Kulkarni
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/c76ffd076a4f494989877dc8f9de7250
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spelling	oai:doaj.org-article:c76ffd076a4f494989877dc8f9de72502021-11-25T06:19:37ZInactive status is an independent predictor of liver transplant waitlist mortality and is associated with a transplant centers median meld at transplant1932-6203https://doaj.org/article/c76ffd076a4f494989877dc8f9de72502021-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8601542/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4> Approximately 30% of patients on the liver transplant waitlist experience at least one inactive status change which makes them temporarily ineligible to receive a deceased donor transplant. We hypothesized that inactive status would be associated with higher mortality which may differ on a transplant centers’ or donor service areas’ (DSA) Median MELD at Transplant (MMaT). <h4>Methods</h4> Multi-state models were constructed (OPTN database;06/18/2013-06/08/2018) using DSA-level and transplant center-level data where MMaT were numerically ranked and categorized into tertiles. Hazards ratios were calculated between DSA and transplant center tertiles, stratified by MELD score, to determine differences in inactive to active transition probabilities. <h4>Results</h4> 7,625 (30.2% of sample registrants;25,216 total) experienced at least one inactive status change in the DSA-level cohort and 7,623 experienced at least one inactive status change in the transplant-center level cohort (30.2% of sample registrants;25,211 total). Inactive patients with MELD≤34 had a higher probability of becoming re-activated if they were waitlisted in a low or medium MMaT transplant center or DSA. Transplant rates were higher and lower re-activation probability was associated with higher mortality for the MELD 26–34 group in the high MMaT tertile. There were no significant differences in re-activation, transplant probability, or waitlist mortality for inactivated patients with MELD≥35 regardless of a DSA’s or center’s MMaT. <h4>Conclusion</h4> This study shows that an inactive status change is independently associated with waitlist mortality. This association differs by a centers’ and a DSAs’ MMaT. Prioritization through care coordination to resolve issues of inactivity is fundamental to improving access.Jonathan MerolaGeliang GanDarren StewartSamantha NoreenDavid MulliganRamesh BatraDanielle HaakinsonYanhong DengSanjay KulkarniPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jonathan Merola Geliang Gan Darren Stewart Samantha Noreen David Mulligan Ramesh Batra Danielle Haakinson Yanhong Deng Sanjay Kulkarni Inactive status is an independent predictor of liver transplant waitlist mortality and is associated with a transplant centers median meld at transplant
description	<h4>Background</h4> Approximately 30% of patients on the liver transplant waitlist experience at least one inactive status change which makes them temporarily ineligible to receive a deceased donor transplant. We hypothesized that inactive status would be associated with higher mortality which may differ on a transplant centers’ or donor service areas’ (DSA) Median MELD at Transplant (MMaT). <h4>Methods</h4> Multi-state models were constructed (OPTN database;06/18/2013-06/08/2018) using DSA-level and transplant center-level data where MMaT were numerically ranked and categorized into tertiles. Hazards ratios were calculated between DSA and transplant center tertiles, stratified by MELD score, to determine differences in inactive to active transition probabilities. <h4>Results</h4> 7,625 (30.2% of sample registrants;25,216 total) experienced at least one inactive status change in the DSA-level cohort and 7,623 experienced at least one inactive status change in the transplant-center level cohort (30.2% of sample registrants;25,211 total). Inactive patients with MELD≤34 had a higher probability of becoming re-activated if they were waitlisted in a low or medium MMaT transplant center or DSA. Transplant rates were higher and lower re-activation probability was associated with higher mortality for the MELD 26–34 group in the high MMaT tertile. There were no significant differences in re-activation, transplant probability, or waitlist mortality for inactivated patients with MELD≥35 regardless of a DSA’s or center’s MMaT. <h4>Conclusion</h4> This study shows that an inactive status change is independently associated with waitlist mortality. This association differs by a centers’ and a DSAs’ MMaT. Prioritization through care coordination to resolve issues of inactivity is fundamental to improving access.
format	article
author	Jonathan Merola Geliang Gan Darren Stewart Samantha Noreen David Mulligan Ramesh Batra Danielle Haakinson Yanhong Deng Sanjay Kulkarni
author_facet	Jonathan Merola Geliang Gan Darren Stewart Samantha Noreen David Mulligan Ramesh Batra Danielle Haakinson Yanhong Deng Sanjay Kulkarni
author_sort	Jonathan Merola
title	Inactive status is an independent predictor of liver transplant waitlist mortality and is associated with a transplant centers median meld at transplant
title_short	Inactive status is an independent predictor of liver transplant waitlist mortality and is associated with a transplant centers median meld at transplant
title_full	Inactive status is an independent predictor of liver transplant waitlist mortality and is associated with a transplant centers median meld at transplant
title_fullStr	Inactive status is an independent predictor of liver transplant waitlist mortality and is associated with a transplant centers median meld at transplant
title_full_unstemmed	Inactive status is an independent predictor of liver transplant waitlist mortality and is associated with a transplant centers median meld at transplant
title_sort	inactive status is an independent predictor of liver transplant waitlist mortality and is associated with a transplant centers median meld at transplant
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/c76ffd076a4f494989877dc8f9de7250
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Inactive status is an independent predictor of liver transplant waitlist mortality and is associated with a transplant centers median meld at transplant

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