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
Research background

There is minimal data on the long-term outcomes of patients with cirrhosis who are declined for liver transplantation. Many of these ineligible patients are followed by general hepatology and gastroenterology providers with the hope of re-eligibility for transplantation. Specific strategies to achieve liver transplant eligibility for these patients have not been studied.

Research motivation

We were motivated to pursue this project so that the field may have a better understanding of the clinical and sociodemographic factors that may predict future liver transplant eligibility for those initially considered ineligible.

Research objectives

The objective of our study was to assess clinical and sociodemographic factors associated with one-year liver transplant eligibility among patients with cirrhosis seen in a transitional care liver clinic who were considered unsuitable transplant candidates but did not have absolute contraindications.

Research methods

Retrospective, single-center study.

Research results

69 patients were identified, predominantly Caucasian men with alcoholic cirrhosis. 46 patients (67%) presented to the first TCLC visit. Seven of 46 patients that presented to the first TCLC visit became transplant candidates at one year, 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).

Research conclusions

Patients ineligible for liver transplantation, but without absolute contraindications, who presented to our TCLC were more likely to be listed for liver transplantation at one year if they were joined by family or friends at the first clinic visit. While more research is needed, patient and family participation in clinical care may serve as a surrogate marker of social support for patients previously declined for liver transplant.

Research perspectives

This study reinforced the importance of investigating the long-term outcomes of patients with cirrhosis who are declined for liver transplantation. Given our small study population and known variations in transplant listing policies at each institution, larger multi-centered prospective studies are needed.