Impact of hepatic encephalopathy on liver transplant waiting list mortality in regions with different transplantation rates

Annarein J. C. Kerbert*, Enric Reverter, Lara Verbruggen, Madelon Tieleman, Miguel Navasa, Bart J. A. Mertens, Sergio Rodriguez-Tajes, Marleen de Vree, Herold J. Metselaar, Fang W. T. Chiang, Hein W. Verspaget, Bart van Hoek, Jaime Bosch, Minneke J. Coenraad

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    2 Citations (Scopus)


    Overt hepatic encephalopathy (OHE) negatively impacts the prognosis of liver transplant candidates. However, it is not taken into account in most prioritizing organ allocation systems. We aimed to assess the impact of OHE on waitlist mortality in 3 cohorts of cirrhotic patients awaiting liver transplantation, with differences in the composition of patient population, transplantation policy, and transplantation rates. These cohorts were derived from two centers in the Netherlands (reference and validation cohort, n = 246 and n = 205, respectively) and one in Spain (validation cohort, n = 253). Competing-risk regression analysis was applied to assess the association of OHE with 1-year waitlist mortality. OHE was found to be associated with mortality, independently of MELD score, other cirrhosis-related complications and hepatocellular carcinoma (HCC; sHR = 4.19, 95% CI = 1.9-9.5, P = 0.001). The addition of extra MELD points for OHE counteracted its negative impact on survival. These findings were confirmed in the Dutch validation cohort, whereas in the Spanish cohort, containing a significantly greater proportion of HCC and with higher transplantation rates, OHE was not associated with mortality. In conclusion, OHE is an independent risk factor for 1-year waitlist mortality and might be a prioritization rule for organ allocation. However, its impact seems to be attenuated in settings with significantly higher transplantation rates.

    Original languageEnglish
    Article number13412
    Number of pages8
    JournalClinical Transplantation
    Issue number11
    Publication statusPublished - Nov-2018


    • hepatic encephalopathy
    • liver disease
    • organ allocation
    • MODEL
    • SCORE
    • BURDEN

    Cite this