DISEASE GRAVITY AND URGENCY OF NEED AS GUIDELINES FOR LIVER ALLOCATION

One thousand one hundred and twenty-eight candidates for liver transpl antation were stratified into five urgency-of-need categories by the U nited Network for Organ Sharing (UNOS) criteria. Most patients of low- risk UNOS 1 status remained alive after 1 yr without transplantation; the mortality while waiting was 3% after a median of 229.5 days. In co ntrast, only 3% of those entered at the highest risk UNOS 5 category s urvived without transplantation; 28% died while waiting, the deaths oc curring at a median of 5.5 days. The UNOS categories in between showed the expected gradations, in which at each higher level fewer patients remained as candidates throughout the 1-yr duration of study while pr ogressively more died at earlier and earlier times while waiting for a n organ. In a separate study of posttransplantation survival during th e same time period, the best postoperative results were in the lowest- risk UNOS 1 and 2 patients (88% combined), and the worst results were those in UNOS 5 (71%). However, a relative risk cross-analysis showed that a negative benefit of transplantation may have been the result in terms of 1-yr survival for the low-risk elective patients, but that a gain in life extension was achieved in the potentially lethal UNOS ca tegories 3, 4 and 5 (greatest for UNOS 3). These findings and conclusi ons are discussed in terms of total care of patients with liver diseas e, and in the context of organ allocation policies of the United State s and Europe.