Liver transplant patients with MELD\u3e50 at listing have poor waitlist outcomes and similar post transplant survival to status 1a patients

Background: Allocation of liver allografts is prioritized to Status 1A patients over end-stage liver disease patients. We aimed to analyze waitlist and transplant outcomes of Status 1A and extremely ill patients with MELD\u3e40 patients. Methods: Using United Network for Organ Sharing registry data, we retrospectively evaluated LT waitlist mortality, probability of LT and survival after LT between adults in the United States with Status 1A or ESLD with MELD \u3e40 listed for LT from July 1st 2013 to March 31st 2017. Competing waitlist outcomes such as death, transplant and removal from list were evaluated using Gray test. Transplant outcomes were analyzed using Kaplan-Meier method and log rank test. Results: During this time period, 611 patients were listed as Status 1A, 1140 were listed with a MELD between 40 to 50 and 62 with MELD\u3e50. Probability of transplant within 7 days was highest in Status 1A compared to MELD 40-50 and MELD\u3e50 (71.0% Vs 55.1% & 54.1%, p\u3c0.001). Death on waitlist within 7 days was highest in MELD\u3e50 compared to MELD 40-50 and Status 1A (22.9% Vs 13.8% & 16.4%, p=0.035). Probability of removal from waitlist within 7 days due to recovery was highest in Status 1A compared to MELD 40-50 and MELD\u3e50 (6.9% Vs 0.1% & 0%, p\u3c0.001). After transplant, no instantaneous 1 year risk of graft loss was observed between MELD\u3e50 and Status 1A (HR 1.8, CI 0.82-4.00, p=0.14) as well as MELD 40-50 and Status 1A (HR 1.07, CI 0.75-1.52, p=0.71). Instantaneous 1 year mortality showed a similar finding (HR 1.82, CI 0.77-4.3, p=0.16 & HR 1.13, CI 0.77-1.65, p=0.53). Conclusion: MELD\u3e50 have higher probability of death within 7 days on waitlist and similar graft and patient survival compared to MELD 40-50 and Status 1A patients. Hence MELD\u3e50 may be considered ahead of Status 1A in the allocation of liver grafts