Impact of hepatic encephalopathy on liver transplant waiting list mortality in regions with different transplantation rates

• Published in: Clinical transplantation Vol. 32; no. 11; pp. e13412 - n/a
• Main Authors: Kerbert, Annarein J. C., Reverter, Enric, Verbruggen, Lara, Tieleman, Madelon, Navasa, Miguel, Mertens, Bart J. A., Rodríguez‐Tajes, Sergio, de Vree, Marleen, Metselaar, Herold J., Chiang, Fang W. T., Verspaget, Hein W., van Hoek, Bart, Bosch, Jaime, Coenraad, Minneke J.
• Format: Journal Article
• Language: English
• Published: Denmark 01-11-2018
• Subjects: Female; Follow-Up Studies; hepatic encephalopathy; Hepatic Encephalopathy - physiopathology; Humans; Liver Cirrhosis - epidemiology; Liver Cirrhosis - mortality; Liver Cirrhosis - pathology; liver disease; Liver Transplantation - mortality; Male; Middle Aged; Netherlands - epidemiology; organ allocation; Prognosis; Retrospective Studies; Risk Factors; Severity of Illness Index; Spain - epidemiology; Survival Rate; Waiting Lists - mortality; Netherlands; Spain; liver disease; organ allocation; hepatic encephalopathy
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/ctr.13412

Overt hepatic encephalopathy (OHE) negatively impacts the prognosis of liver transplant candidates. However, it is not taken into account in most prioritizing organ allocation systems. We aimed to assess the impact of OHE on waitlist mortality in 3 cohorts of cirrhotic patients awaiting liver transplantation, with differences in the composition of patient population, transplantation policy, and transplantation rates. These cohorts were derived from two centers in the Netherlands (reference and validation cohort, n = 246 and n = 205, respectively) and one in Spain (validation cohort, n = 253). Competing‐risk regression analysis was applied to assess the association of OHE with 1‐year waitlist mortality. OHE was found to be associated with mortality, independently of MELD score, other cirrhosis‐related complications and hepatocellular carcinoma (HCC; sHR = 4.19, 95% CI = 1.9‐9.5, P = 0.001). The addition of extra MELD points for OHE counteracted its negative impact on survival. These findings were confirmed in the Dutch validation cohort, whereas in the Spanish cohort, containing a significantly greater proportion of HCC and with higher transplantation rates, OHE was not associated with mortality. In conclusion, OHE is an independent risk factor for 1‐year waitlist mortality and might be a prioritization rule for organ allocation. However, its impact seems to be attenuated in settings with significantly higher transplantation rates.