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Mortality on the UNOS Waitlist for Patients with Autoimmune Liver Disease

Background: Outcomes on the liver transplant waitlist can vary by etiology. Our aim is to investigate differences in waitlist mortality of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) using the United Network for Organ Sharing (UNOS) databas...

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Autores principales: Suri, Jaspreet S., Danford, Christopher J., Patwardhan, Vilas, Bonder, Alan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074547/
https://www.ncbi.nlm.nih.gov/pubmed/31979326
http://dx.doi.org/10.3390/jcm9020319
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author Suri, Jaspreet S.
Danford, Christopher J.
Patwardhan, Vilas
Bonder, Alan
author_facet Suri, Jaspreet S.
Danford, Christopher J.
Patwardhan, Vilas
Bonder, Alan
author_sort Suri, Jaspreet S.
collection PubMed
description Background: Outcomes on the liver transplant waitlist can vary by etiology. Our aim is to investigate differences in waitlist mortality of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) using the United Network for Organ Sharing (UNOS) database. Methods: We identified patients who were listed for liver transplantation from 1987 to 2016 with a primary diagnosis of AIH, PBC, or PSC. We excluded patients with overlap syndromes, acute hepatic necrosis, missing data, and those who were children. The primary outcome was death or removal from the waitlist due to clinical deterioration. We compared waitlist survival using competing risk analysis. Results: Between 1987 and 2016, there were 7412 patients listed for liver transplant due to AIH, 8119 for PBC, and 10,901 for PSC. Patients with AIH were younger, more likely to be diabetic, and had higher listing model for end-stage liver disease (MELD) scores compared to PBC and PSC patients. Patients with PBC and AIH were more likely to be removed from the waitlist due to death or clinical deterioration. On competing risk analysis, AIH patients had a similar risk of being removed from the waitlist compared to those with PBC (subdistribution hazard ratio (SHR) 0.94, 95% CI 0.85–1.03) and higher risk of removal compared to those with PSC (SHR 0.8, 95% CI 0.72 to 0.89). Conclusion: Autoimmune hepatitis carries a similar risk of waitlist removal to PBC and a higher risk than PSC. The etiology of this disparity is not entirely clear and deserves further investigation.
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spelling pubmed-70745472020-03-20 Mortality on the UNOS Waitlist for Patients with Autoimmune Liver Disease Suri, Jaspreet S. Danford, Christopher J. Patwardhan, Vilas Bonder, Alan J Clin Med Article Background: Outcomes on the liver transplant waitlist can vary by etiology. Our aim is to investigate differences in waitlist mortality of autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), and primary sclerosing cholangitis (PSC) using the United Network for Organ Sharing (UNOS) database. Methods: We identified patients who were listed for liver transplantation from 1987 to 2016 with a primary diagnosis of AIH, PBC, or PSC. We excluded patients with overlap syndromes, acute hepatic necrosis, missing data, and those who were children. The primary outcome was death or removal from the waitlist due to clinical deterioration. We compared waitlist survival using competing risk analysis. Results: Between 1987 and 2016, there were 7412 patients listed for liver transplant due to AIH, 8119 for PBC, and 10,901 for PSC. Patients with AIH were younger, more likely to be diabetic, and had higher listing model for end-stage liver disease (MELD) scores compared to PBC and PSC patients. Patients with PBC and AIH were more likely to be removed from the waitlist due to death or clinical deterioration. On competing risk analysis, AIH patients had a similar risk of being removed from the waitlist compared to those with PBC (subdistribution hazard ratio (SHR) 0.94, 95% CI 0.85–1.03) and higher risk of removal compared to those with PSC (SHR 0.8, 95% CI 0.72 to 0.89). Conclusion: Autoimmune hepatitis carries a similar risk of waitlist removal to PBC and a higher risk than PSC. The etiology of this disparity is not entirely clear and deserves further investigation. MDPI 2020-01-23 /pmc/articles/PMC7074547/ /pubmed/31979326 http://dx.doi.org/10.3390/jcm9020319 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Suri, Jaspreet S.
Danford, Christopher J.
Patwardhan, Vilas
Bonder, Alan
Mortality on the UNOS Waitlist for Patients with Autoimmune Liver Disease
title Mortality on the UNOS Waitlist for Patients with Autoimmune Liver Disease
title_full Mortality on the UNOS Waitlist for Patients with Autoimmune Liver Disease
title_fullStr Mortality on the UNOS Waitlist for Patients with Autoimmune Liver Disease
title_full_unstemmed Mortality on the UNOS Waitlist for Patients with Autoimmune Liver Disease
title_short Mortality on the UNOS Waitlist for Patients with Autoimmune Liver Disease
title_sort mortality on the unos waitlist for patients with autoimmune liver disease
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074547/
https://www.ncbi.nlm.nih.gov/pubmed/31979326
http://dx.doi.org/10.3390/jcm9020319
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