{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T07:08:19Z","timestamp":1781334499203,"version":"3.54.1"},"reference-count":31,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,11,16]],"date-time":"2021-11-16T00:00:00Z","timestamp":1637020800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Historically, patients with primary biliary cholangitis (PBC) experience waitlist mortality and low rates of liver transplant (LT). Herein, the impact of MELD\u2010Na based allocation on PBC waitlist mortality was examined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Adult patients with PBC were compared to those with alcohol\u2010related liver disease (ALD) or non\u2010alcoholic steatohepatitis (NASH) listed for LT from 2013 to 2019 in OPTN. Competing risk regression evaluated waitlist mortality in the MELD and MELD\u2010Na eras using propensity score weights.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall, 1508 patients with PBC, 13581 with ALD, and 10455 with NASH were examined. In the MELD\u2010Na era, 24\u2010month cumulative incidence of waitlist mortality for PBC was 23.0% (95%CI 19.7\u201326.5%), ALD 13.9% (95%CI 13.1\u201314.8%), and NASH 20.0% (95%CI 18.9\u201321.2%). Using propensity score weights, adjusted risk of waitlist mortality was higher for PBC versus ALD (HR\u00a0=\u00a01.45, 95%CI 1.22\u20131.71) and NASH (HR\u00a0=\u00a01.32, 95%CI 1.14\u20131.55). Furthermore, among PBC, waitlist mortality risk per five\u2010point elevation in MELD\u2010Na (HR\u00a0=\u00a01.22, 95%CI 1.11\u20131.35) and Karnofsky score \u226430% (HR\u00a0=\u00a02.02, 95%CI 1.39\u20132.92) was significantly higher than among ALD (HR\u00a0=\u00a01.08, 95%CI 1.04\u20131.13; HR\u00a0=\u00a01.28, 95%CI 1.10\u20131.49) and NASH (HR\u00a0=\u00a01.05, 95%CI 1.00\u20131.09; HR\u00a0=\u00a01.16, 95%CI .99\u20131.37; all <jats:italic>P<\/jats:italic>\u2010interactions\u00a0&lt;\u00a0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The MELD\u2010Na score continues to underestimate risk of waitlist death for patients with PBC relative to ALD and NASH and highlights need for additional score modifications or exceptions.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.14527","type":"journal-article","created":{"date-parts":[[2021,11,3]],"date-time":"2021-11-03T16:45:25Z","timestamp":1635957925000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Excess liver transplant waitlist mortality for patients with primary biliary cholangitis under MELD\u2010Na allocation"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8554-2906","authenticated-orcid":false,"given":"Kali","family":"Zhou","sequence":"first","affiliation":[{"name":"Division of Gastrointestinal and Liver Diseases Keck School of Medicine University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Dodge","sequence":"additional","affiliation":[{"name":"Division of Gastrointestinal and Liver Diseases Keck School of Medicine University of Southern California  Los Angeles California USA"},{"name":"Department of Population and Public Health Sciences University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edison","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Medicine Keck School of Medicine University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4238-3057","authenticated-orcid":false,"given":"Juliet","family":"Emamaullee","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Kahn","sequence":"additional","affiliation":[{"name":"Division of Gastrointestinal and Liver Diseases Keck School of Medicine University of Southern California  Los Angeles California 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