Impact of a Transplantation Critical Care Model on Short-Term Outcomes Following Liver Transplantation in High Acuity Patients: A Single-Center Experience

Transplant Proc. 2018 Dec;50(10):3544-3548. doi: 10.1016/j.transproceed.2018.08.013. Epub 2018 Sep 3.


Background: Orthotopic liver transplantation (OLT) is the definitive treatment for end-stage liver disease (ESLD). Patients with high acuity ESLD are frequently denied life-saving OLT by transplant centers due to reported inferior outcomes. We sought to analyze the impact of a specialized transplant critical care model (TCCM) on patient access to OLT and survival outcomes in high acuity patients.

Methods: From January 2009 to December 2016, 122 adults were wait-listed at our transplant center with laboratory Model for ESLD ≥35 or Status I. Outcomes in Era I (prior to TCCM) were compared to Era II (TCCM established October 1, 2012).

Results: Era II (TCCM) led to a significant increase in patients' access to OLT. Frequency and need to seek OLT at another center dropped 4-fold in Era II. Compared to Era I, the majority of patients in Era II required intensive care unit management (22% vs 83%, P < .01) and renal replacement therapy (11% vs 70%, P < .01) prior to OLT. Despite a higher acuity of illness in Era II, 1-year patient survival was comparable (89% Era I, 80% Era II, P = .35).

Conclusion: Implementation of a specialized TCCM expanded OLT access to high acuity patients, reduced the need to seek higher level of care elsewhere, and achieved excellent short-term post-transplant survival outcomes.

MeSH terms

  • Adult
  • Critical Care / methods*
  • End Stage Liver Disease / mortality
  • End Stage Liver Disease / surgery*
  • Female
  • Graft Survival
  • Humans
  • Intensive Care Units
  • Liver Transplantation / methods*
  • Liver Transplantation / mortality
  • Male
  • Middle Aged
  • Patient Selection*
  • Retrospective Studies
  • Treatment Outcome