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CAUSES OF DEATH AMONG ALL NOVA SCOTIANS REFERRED TO THE ATLANTIC MULTI-ORGAN TRANSPLANT PROGRAM (MOTP) BETWEEN 1996 AND 2002

F Alsohaibani, C Skedgel¹, J Douglas¹, M McNeil², J Copeland², KM Peltekian
Departments of Medicine (¹Office of Outcomes Research, and Health Economics) and ²Nursing, Capital District Health Authority, Halifax, Nova Scotia

Liver transplant programs usually focus on outcomes of those undergoing transplantation surgery. There are often more patients with end-stage liver disease who are referred to the program but do not undergo transplantation. These patients contribute significantly to the workload but often their outcomes are not followed. In this study we compare the outcomes and causes of death for all patients referred to MOTP.
METHODS: Clinical data (including referral and liver transplant dates) from MOTP were linked through Dalhousie Population Health Research Unit to the administrative data from 1996/97 to 2003/04. This administrative database includes only those covered by Nova Scotia Medical Services Insurance. Date and cause of death for those transplanted and those not transplanted were extracted from Nova Scotia Vital Statistics data.
RESULTS: 404 Nova Scotians were referred to MOTP, with 173 undergoing liver transplantation between 1996 and 2001. Mean age was 51 yrs with 59% males. The reasons for not transplanting these patients included: death on wait list, contraindications for liver transplant, too sick for liver transplant, too early for liver transplant and reversible acute liver disease. The Kaplan-Meier survival curves showed a 5-yr survival of 82% in the transplanted group and 47% in the non-transplanted group (p < 0.001). The top 5 cause of death in non-transplanted group included liver disease 49%, neoplasm 14%, infectious disease (including hepatitis C) 13%, metabolic and cardiac each with 7% and overdose 3%. In transplanted patients, the cause of death was listed as liver disease in 44%, infectious disease 19%, cardiac 13%, neoplasm 9% and renal 3%.
CONCLUSION: This is the first time, outcomes and causes of death have been reported for those referred for end-stage liver disease but not transplanted. In spite, the limitations to reporting of causes of death, these results are necessary for health care costing.
This research was funded by the Capital Health Research Foundation

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