2009b) Effect of alcoholic liver disease and hepatitis C infection on waiting list and posttransplant mortality and transplant survival benefit. Hepatology 50

Disease-specific analysis of liver transplant survival benefit, which encompasses both pre- and post-transplant events, has not been reported. Therefore, we evaluated the effect of alcoholic liver disease (ALD) and hepatitis C virus (HCV) infection onwaiting listmortality, posttransplantmortality, and thesurvivalbenefitofdeceaseddonorliver transplantationusingUnitedStatesdatafromtheScientific Registry of Transplant Recipients on 38,899 adults placed on the transplant waiting list between September 2001 and December 2006. Subjects were classified according to the presence/absence of HCV and ALD. Cox regression was used to estimate waiting list mortality and posttransplant mor-tality separately. Survival benefit was assessed using sequential stratification. Overall, the presence of HCV significantly increased waiting list mortality, with a covariate-adjusted hazard ratio (HR) for HCV-positive (HCV) compared with HCV-negative (HCV) HR 1.19 (P 0.0001). The impact of HCV was significantly more pronounced (P 0.001) among ALD-positive (ALD) patients (HR 1.36; P< 0.0001), but was still significant among ALD-negative (ALD) patients (HR 1.11; P 0.02). The contrast between ALD and ALDwaiting list mortality was signifi-cantonlyamongHCVpatients (HR1.14;P0.006).Posttransplantmortalitywas significantly increased amongHCV (versusHCV) patients (HR1.26;P0.0009), but not amongALD (versus ALD) patients. Survival benefit of transplantation was significantly decreased among HCV comparedwithHCV recipientswithmodel for end-stage liverdisease (MELD)scores9-29, but was significantly increased at MELD>30. ALD did not influence the survival benefit of trans-plantation at any MELD score. Conclusion: Except in patients with very low or very high MELD scores,HCVstatushas a significantnegative impact on the survival benefitof liver transplantation. In contrast, the presence of ALDdoes not influence liver transplant survival benefit. (HEPATOLOGY 2009