Outcomes of critically ill patients denied consideration for liver transplantation

Patients with advanced liver disease (ALD) leading to admission to the ICU are often evaluated for possible orthotopic liver transplantation (OLT). Th ose deemed ineligible for listing for OLT must be managed by medical therap y. The number of patients not eligible for OLT listing will likely increase given the current organ transplant shortage. We performed a retrospective multivariate analysis of mortality predictors for patients denied listing f or OLT, One hundred and eighty-three patients denied OLT listing were evalu ated over a 3(1)/(2)-yr period, beginning in 1994. Overall mortality was 56 % for those not listed versus 12% for those listed for OLT (p < 0.001). Ind ependent predictors of increased mortality among those not listed were APAC HE II score (p = 0.001; OR 1.11), sepsis (p = 0.04; OR 2.41), and the need for mechanical Ventilation (p = 0.001; OR 3.71). Gastrointestinal (CI) blee ding was associated with decreased mortality (p = 0.02; OR 0.44), We conclu de that critically ill patients with ALD denied OLT listing have substantia lly higher mortality than those listed for OLT. APACHE II score, sepsis, an d the need for mechanical ventilation predict increased mortality in this g roup. Conversely, GI bleeding predicts decreased mortality; therefore, aggr essive resuscitative measures seem merited in these patients.