Survival benefit of liver transplantation and the effect of underlying liver disease

Ana L. Gleisner, Alvaro Muñoz, Ajacio Brandao, Claudio Marroni, Maria Lucia Zanotelli, Guido Gracco Cantisani, Leila Beltrami Moreira, Michael A. Choti, Timothy M. Pawlik

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Abstract

Background: The benefit of liver transplantation relative to initial degree of underlying liver disease and time on the waiting list remains poorly defined. We sought to examine the survival benefit attributable to liver transplantation across a wide range of Model for End-Stage Liver Disease (MELD) scores. Methods: The study population included patients with end-stage liver disease enlisted in Rio Grande do Sul, Brazil, between 2001 and 2005. Survival and hazard function for enlisted and transplanted patients were estimated using parametric and nonparametric methods. MELD score was utilized to account for underlying liver disease. Results: Of 1,130 eligible patients, 520 (46.0%) were transplanted, 266 (23.5%) died on the waiting list, 141 (12.5%) were excluded from the waiting list, and 203 (18.0%) remained enlisted and were awaiting transplantation at the time of last observation. At 1 year after transplantation, a MELD score of 15 represented a transition point in terms of overall survival benefit (MELD 10, 90% vs 83%; MELD 15, 81% vs 80%; MELD 20, 63% vs 78%; MELD 25, 42% vs 74%; MELD 30, 21% vs71%; enlisted vs transplant patients, respectively). MELD scores at which transplantation seemed to be beneficial relative to the amount of follow-up time was MELD 23, 17, 15, and 12 at 6 months, and 1, 2, and 5 years, respectively, from time of transplantation/enlistment. Conclusion: Although patients with greater MELD scores enjoy a pronounced and early benefit from transplantation, patients with lesser MELD scores do gain from transplantation, although a greater period of time is needed to realize the survival benefit.

Original languageEnglish (US)
Pages (from-to)392-404
Number of pages13
JournalSurgery
Volume147
Issue number3
DOIs
StatePublished - Mar 2010

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End Stage Liver Disease
Liver Transplantation
Liver Diseases
Survival
Transplantation
Waiting Lists
Brazil

ASJC Scopus subject areas

  • Surgery

Cite this

Gleisner, A. L., Muñoz, A., Brandao, A., Marroni, C., Zanotelli, M. L., Cantisani, G. G., ... Pawlik, T. M. (2010). Survival benefit of liver transplantation and the effect of underlying liver disease. Surgery, 147(3), 392-404. https://doi.org/10.1016/j.surg.2009.10.006

Survival benefit of liver transplantation and the effect of underlying liver disease. / Gleisner, Ana L.; Muñoz, Alvaro; Brandao, Ajacio; Marroni, Claudio; Zanotelli, Maria Lucia; Cantisani, Guido Gracco; Moreira, Leila Beltrami; Choti, Michael A.; Pawlik, Timothy M.

In: Surgery, Vol. 147, No. 3, 03.2010, p. 392-404.

Research output: Contribution to journalArticle

Gleisner, AL, Muñoz, A, Brandao, A, Marroni, C, Zanotelli, ML, Cantisani, GG, Moreira, LB, Choti, MA & Pawlik, TM 2010, 'Survival benefit of liver transplantation and the effect of underlying liver disease', Surgery, vol. 147, no. 3, pp. 392-404. https://doi.org/10.1016/j.surg.2009.10.006
Gleisner AL, Muñoz A, Brandao A, Marroni C, Zanotelli ML, Cantisani GG et al. Survival benefit of liver transplantation and the effect of underlying liver disease. Surgery. 2010 Mar;147(3):392-404. https://doi.org/10.1016/j.surg.2009.10.006
Gleisner, Ana L. ; Muñoz, Alvaro ; Brandao, Ajacio ; Marroni, Claudio ; Zanotelli, Maria Lucia ; Cantisani, Guido Gracco ; Moreira, Leila Beltrami ; Choti, Michael A. ; Pawlik, Timothy M. / Survival benefit of liver transplantation and the effect of underlying liver disease. In: Surgery. 2010 ; Vol. 147, No. 3. pp. 392-404.
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abstract = "Background: The benefit of liver transplantation relative to initial degree of underlying liver disease and time on the waiting list remains poorly defined. We sought to examine the survival benefit attributable to liver transplantation across a wide range of Model for End-Stage Liver Disease (MELD) scores. Methods: The study population included patients with end-stage liver disease enlisted in Rio Grande do Sul, Brazil, between 2001 and 2005. Survival and hazard function for enlisted and transplanted patients were estimated using parametric and nonparametric methods. MELD score was utilized to account for underlying liver disease. Results: Of 1,130 eligible patients, 520 (46.0{\%}) were transplanted, 266 (23.5{\%}) died on the waiting list, 141 (12.5{\%}) were excluded from the waiting list, and 203 (18.0{\%}) remained enlisted and were awaiting transplantation at the time of last observation. At 1 year after transplantation, a MELD score of 15 represented a transition point in terms of overall survival benefit (MELD 10, 90{\%} vs 83{\%}; MELD 15, 81{\%} vs 80{\%}; MELD 20, 63{\%} vs 78{\%}; MELD 25, 42{\%} vs 74{\%}; MELD 30, 21{\%} vs71{\%}; enlisted vs transplant patients, respectively). MELD scores at which transplantation seemed to be beneficial relative to the amount of follow-up time was MELD 23, 17, 15, and 12 at 6 months, and 1, 2, and 5 years, respectively, from time of transplantation/enlistment. Conclusion: Although patients with greater MELD scores enjoy a pronounced and early benefit from transplantation, patients with lesser MELD scores do gain from transplantation, although a greater period of time is needed to realize the survival benefit.",
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AU - Brandao, Ajacio

AU - Marroni, Claudio

AU - Zanotelli, Maria Lucia

AU - Cantisani, Guido Gracco

AU - Moreira, Leila Beltrami

AU - Choti, Michael A.

AU - Pawlik, Timothy M.

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N2 - Background: The benefit of liver transplantation relative to initial degree of underlying liver disease and time on the waiting list remains poorly defined. We sought to examine the survival benefit attributable to liver transplantation across a wide range of Model for End-Stage Liver Disease (MELD) scores. Methods: The study population included patients with end-stage liver disease enlisted in Rio Grande do Sul, Brazil, between 2001 and 2005. Survival and hazard function for enlisted and transplanted patients were estimated using parametric and nonparametric methods. MELD score was utilized to account for underlying liver disease. Results: Of 1,130 eligible patients, 520 (46.0%) were transplanted, 266 (23.5%) died on the waiting list, 141 (12.5%) were excluded from the waiting list, and 203 (18.0%) remained enlisted and were awaiting transplantation at the time of last observation. At 1 year after transplantation, a MELD score of 15 represented a transition point in terms of overall survival benefit (MELD 10, 90% vs 83%; MELD 15, 81% vs 80%; MELD 20, 63% vs 78%; MELD 25, 42% vs 74%; MELD 30, 21% vs71%; enlisted vs transplant patients, respectively). MELD scores at which transplantation seemed to be beneficial relative to the amount of follow-up time was MELD 23, 17, 15, and 12 at 6 months, and 1, 2, and 5 years, respectively, from time of transplantation/enlistment. Conclusion: Although patients with greater MELD scores enjoy a pronounced and early benefit from transplantation, patients with lesser MELD scores do gain from transplantation, although a greater period of time is needed to realize the survival benefit.

AB - Background: The benefit of liver transplantation relative to initial degree of underlying liver disease and time on the waiting list remains poorly defined. We sought to examine the survival benefit attributable to liver transplantation across a wide range of Model for End-Stage Liver Disease (MELD) scores. Methods: The study population included patients with end-stage liver disease enlisted in Rio Grande do Sul, Brazil, between 2001 and 2005. Survival and hazard function for enlisted and transplanted patients were estimated using parametric and nonparametric methods. MELD score was utilized to account for underlying liver disease. Results: Of 1,130 eligible patients, 520 (46.0%) were transplanted, 266 (23.5%) died on the waiting list, 141 (12.5%) were excluded from the waiting list, and 203 (18.0%) remained enlisted and were awaiting transplantation at the time of last observation. At 1 year after transplantation, a MELD score of 15 represented a transition point in terms of overall survival benefit (MELD 10, 90% vs 83%; MELD 15, 81% vs 80%; MELD 20, 63% vs 78%; MELD 25, 42% vs 74%; MELD 30, 21% vs71%; enlisted vs transplant patients, respectively). MELD scores at which transplantation seemed to be beneficial relative to the amount of follow-up time was MELD 23, 17, 15, and 12 at 6 months, and 1, 2, and 5 years, respectively, from time of transplantation/enlistment. Conclusion: Although patients with greater MELD scores enjoy a pronounced and early benefit from transplantation, patients with lesser MELD scores do gain from transplantation, although a greater period of time is needed to realize the survival benefit.

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