Defense Date


Document Type


Degree Name

Master of Public Health


Epidemiology & Community Health

First Advisor

Resa Jones


Background: The evaluation process for listing a patient on the liver transplant list is complicated and involves multiple consultations from various specialists, as well as extensive imaging and physiological studies. Although there are data on the outcomes of those listed, we know little about those that are denied listing. This research project will identify the reasons for liver transplant listing denial and predictors of death following denial for this challenging group of patients. Methods: Data from all patients (n=1,500) evaluated for a liver transplant from 1997 to 2007 by the Department of Gastroenterology, Hepatology, and Nutrition located at Virginia Commonwealth University Health System’s (VCUHS) Hume-Lee Transplant Program were reviewed to identify patients denied listing (n=350). Simple descriptive characteristics were generated and the reasons for denial were assessed. The Social Security Death Index was used to determine and/or confirm mortality and multiple logistic regression was conducted to determine the predictors of death following denial of transplant listing. Results: The majority of the denied patients were white males and the mean age was 50.9, SE= 0.542). The primary liver disease diagnosis for those denied listing was Hepatitis C Virus (HCV) (33.6%). Study participants whose primary diagnosis was ethyl alcohol abuse or hepatocellular carcinoma had greater odds of dying after not being listed when compared to those diagnosed with HCV; however, these findings were not statistically significant. The majority of participants were denied listing for Hepatic-related (38.8%), psychosocial-related (21.7%), and cardiac-related (15.7%) reasons. Men were two times more likely to die after denial than women (OR= 2.18, CI= 1.03, 4.62). Patients with a MELD score less than 30 were less likely to die after being denied listing compared to those with MELD scores 31 to 40. The risk of dying after denial was not statistically different for patients who were denied listing for hepatic-related and cardiac-related reasons compared to subjects who were denied for cancer. Conclusions: Our findings have clear implications for the future of transplant medicine and raise additional questions. The analysis shows men, those 51 years of age and older and patients with MELD scores between 31 and 40 are more likely to die after not being listed for transplant. We did not find significant evidence that those with particular primary liver disease diagnoses were more likely to die following denial for listing. Other studies taking into account the population of patients that are listed as well as those denied listing are necessary in order to understand the patho-physiological mechanisms so that patient-specific therapies may be developed if appropriate.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

May 2009

Included in

Epidemiology Commons