2. Patients may be referred for living donor liver transplantation when:

3. They have intractable symptoms not captured by the MELD data elements

4. The treating physician thinks the patient won’t live long enough to receive a cadaveric organ

5. The MELD score gives greater weight to creatinine and INR over bilirubin

6. Patients with cholestatic liver disease, notably primary sclerosing cholangitis (PSC), may have reduced access to cadaveric transplants, and be preferentially referred for living donor transplantation by clinicians to:

7. Attempt to compensate for patients’ reduced access to cadaveric transplants under the MELD-based allocation system

9. Excluded patients <18 years old, patients listed for retransplantation, and patients with fulminant hepatic failure.

10. We used mixed-effects logistic regression (treating center as fixed effect) to assess the relationship between risk of having a living donor transplant and:

11. Diagnosis (PSC vs. non-PSC)

12. Time period (pre-MELD vs. post-MELD)

13. Interaction between diagnosis and time period

14. Primary analysis: 12/1/1994-5/31/2009

16. Future research is needed to determine whether the practice of selectively transplanting patients with PSC with living donor transplants is associated with differences in clinical outcomes.

17. If patients with PSC are preferentially given LDLTs under the MELD system, and the supply of this resource continues to decline, these trends likely will disadvantage patients with PSC.