The Transplant Index (TI): A Novel Method To Predict Adult Liver Transplant Waitlist Outcomes

Background The field of transplantation is shifting outcome priorities from 1-year survival to more comprehensive metrics including transplant rate and waitlist mortality. Identifying disenfranchised candidates (high waitlist death risk, low transplantation chance) can be a focus to improve outcomes. Methods Given waitlist outcomes, (continued waiting, death, and transplantation), we aimed to identify factors predicting the likelihood candidates would undergo transplant or death by performing multivariate competing risk analyses of 121 198 candidates in the United Network for Organ Sharing database. We incorporated these probabilities (likelihood of transplantation and waitlist death) into the transplant index (TI) to identify disenfranchised candidates (high likelihood of death, low likelihood of transplantation). Results Half of the patients had low incidences of death and transplantation within 90 days (TI-inactive). The remaining were stratified into 10 groups within a predictive index, the TI. Low-TI groups (TI-10, 20, 30) had 90-day transplant rates of 50.8%, 41.6%, and 39.8% respectively, and their respective 90-day death rates were 22.8%, 15.1%, and 10.9%. High-TI groups (TI 80, 90, >90) had 90-day transplantation rates of 53.7%, 64.3%, and 73.9% respectively, and 90-day death rates of 5.9%, 6.5%, and 6.7% respectively. As TI increased, the likelihood of transplantation increased and that of death decreased. Low-TI groups represent the disenfranchised candidates. Conclusions The TI identifies disenfranchised candidates on the adult liver transplant waitlist. This is the subgroup that would benefit the most from efforts to increase access to transplantation. CORRESPONDING AUTHOR CONTACT INFORMATION: Abbas Rana, MD, Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Baylor College of Medicine, One Baylor Plaza, MS:BCM 390, Houston, Texas 77030, USA. (713) 321-8423. abbas.rana@bcm.edu AUTHORSHIP STATEMENT Abbas Rana participated in conceptualization of the study, data analysis and drafting the initial manuscript. Jessie Wu and Hao Liu participated in the conceptualization of the study and the data analysis. Michael Kueht, Syed Shahyan Bakhtiyar, John Goss, Warren H. Chan, Ronald Cotton, Nhu Thao Galvan, Christine O'Mahony, Henrik Petrowsky, Irbaz B. Riaz, Abbas Rana, Jessie Wu, and Hao Liu reviewed, revised, and approved the final manuscript. FUNDING SOURCE No funding was secured for this study. FINANCIAL DISCLOSURE The authors have no financial relationships relevant to this article to disclose. CONFLICT OF INTEREST The authors have no conflicts of interest to disclose Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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