Author

Arvind Venkat

Date of Award

1-1-2000

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Dr. Amy Friedman

Abstract

The increasing number of patients with end-stage liver disease (ESLD) listed for transplantation has forced physicians to examine the disparities in waiting times (WT) for this procedure across the US. The debate has centered upon whether physicians within regions with longer WT, such as that of Yale, are listing patients prematurely compared to regions with shorter WT . Using regional variations in WT, per this argument, to analyze access to organs is therefore misleading. To determine the appropriateness of listing practices at Yale, the authors applied stratification guidelines for liver transplant candidates adopted by the United Network for Organ Sharing (UNOS) on 1/19/98 to patients listed for transplantation at Yale as of 11/14/97. Medical records were reviewed to confirm clinical histories, and referring physicians were contacted to obtain data from within four months of 11/14/97. Patients were reclassified per UNOS guidelines and followed until 7/1/99 to determine prognosis. Of the original cohort of 89 patients, 8 patients had died prior to reclassification; 2 had been lost to follow-up. Of the remaining 79 patients, 40/79 (50.6%) met criteria for severe ESLD, and an additional 29/79 (36.7%) met minimal listing criteria (MLC); a total of 87.3% met criteria for listing for transplantation. Of the 10 patients who did not meet MLC, by 7/1/99. 4 were listed after appeal to the regional review board under circumstances not covered by UNOS guidelines, 4 clinically worsened and were actively listed, and 2 remained clinically well. By 7/1/99, 1 patient was found to meet MLC, but was clinically too well to offer transplantation, and 1 additional patient had been lost to follow up. On 7/1/99, 3/86 (3.4%) patients in the original cohort did not meet MLC for transplantation. There is no evidence that long WT have led to premature listing of liver transplant candidates at Yale.

Comments

This is an Open Access Thesis.

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