Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Apr 27, 2019; 11(4): 370-378
Published online Apr 27, 2019. doi: 10.4254/wjh.v11.i4.370
Being accompanied to liver discharge clinic: An easy measure to identify potential liver transplant candidates among those previously considered ineligible
Jordan Sack, Nilofar Najafian, Angela DeLisle, Simona Jakab
Jordan Sack, Nilofar Najafian, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, United States
Angela DeLisle, Northeast Medical Group, Yale New Haven Health, New Haven, CT 06510, United States
Simona Jakab, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT 06510, United States
Author contributions: All authors helped to perform the research; Sack J contributed to manuscript writing, study design and data analysis; Najafian N contributed to manuscript editing and data collection; DeLisle A contributed to study design and data collection; Jakab S contributed to manuscript editing, study design and data analysis.
Institutional review board statement: This study was reviewed and approved by Yale University Institutional Review Board.
Informed consent statement: Informed consent was not required for this study per the Yale University Institutional Review Board. Data was collected anonymously.
Conflict-of-interest statement: All authors declare no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Simona Jakab, MD, Associate Professor, Section of Digestive Diseases, Yale University School of Medicine, 333 Cedar Street, LMP 1080, New Haven, CT 06510, United States.
Telephone: +1-203-7854138 Fax: +1-203-7857273
Received: February 12, 2019
Peer-review started: February 13, 2019
First decision: March 14, 2019
Revised: March 21, 2019
Accepted: April 8, 2019
Article in press: April 8, 2019
Published online: April 27, 2019

Patients with cirrhosis deemed ineligible for liver transplantation are usually followed in general hepatology or gastroenterology clinics, with the hope of re-evaluation once they meet the appropriate criteria. Specific strategies to achieve liver transplant eligibility for these patients have not been studied.


To assess clinical and sociodemographic factors associated with future liver transplant eligibility among patients initially considered ineligible.


This is a retrospective study of patients with cirrhosis considered non-transplant eligible, but without absolute contraindications, who were scheduled in our transitional care liver clinic (TCLC) after discharge from an inpatient liver service. Transplant candidacy was assessed 1 year after the first scheduled TCLC visit. Data on clinical and sociodemographic factors were collected.


Sixty-nine patients were identified and the vast majority were Caucasian men with alcoholic cirrhosis. 46 patients (67%) presented to the first TCLC visit. Seven of 46 patients that showed to the first TCLC visit became transplant candidates, while 0 of 23 patients that no-showed did (15.2% vs 0%, P = 0.08). Six of 7 patients who showed and became transplant eligible were accompanied by family or friends at the first TCLC appointment, compared to 13 of 39 patients who showed and did not become transplant eligible (85.7% vs 33.3%, P = 0.01).


Patients who attended the first post-discharge TCLC appointment had a trend for higher liver transplant eligibility at 1 year. Being accompanied by family or friends during the first TCLC visit correlated with higher liver transplant eligibility at 1 year (attendance by family or friends was not requested). Patient and family engagement in the immediate post-hospitalization period may predict future liver transplant eligibility for patients previously declined.

Keywords: Cirrhosis, Transitional clinic, Transplant listing, Support, Family

Core tip: Being declined as a liver transplant candidate is not always an irreversible decision, but there is limited information about predictors for eventually achieving liver transplant eligibility. This study shows that among patients who were found not to be transplant candidates, those who presented to their post hospital discharge liver clinic appointment with family and friends had a higher chance of liver transplant eligibility within one year. This finding suggests the importance of engaging family and friends in the complex care of patients with cirrhosis.