Prediction of survival after liver transplantation by pre-transplant parameters

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Prediction of survival after liver transplantation by pre-transplant parameters

Authors: Tobias J. Weismller a; Jana Prokein b; Becker c; Hannelore Barg-Hock c; Jurgen Klempnauer c; P. Manns a; Christian P. Strassburg a

Affiliations:

a Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany

b Institute of Biometry, Hannover Medical School, Hannover, Germany

c Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany

DOI: 10.1080/00365520801932944

Publication Frequency: 12 issues per year

Published in: Scandinavian Journal of Gastroenterology, Volume 43, Issue 6 2008 , pages 736 - 746 First Published: 2008 Subjects: Gastroenterology; Gastrointestinal & Abdominal Surgery;

Formats available: HTML (English) : PDF (English)

Abstract

Objective. Score-based medical urgency criteria are used for necessity-oriented liver transplantation (OLT) but lead to an increasing number of complications in patients with reduced post-OLT survival. A prediction of outcome would improve preoperative patient selection and management.

Material and methods. One-hundred-and-thirty-three consecutive adult patients (63.9% men, mean age 47.4±11.2 years) given transplants between May 2004 and November 2005 at the Hannover Medical School were analysed retrospectively using univariate and multivariate methods.

Results. Indications were: 27.1% viral hepatitis, 19.6% primary sclerosing cholangitis, 15.0% alcoholic liver disease, 7.5% metabolic liver disease, 6.8% primary biliary cirrhosis. Overall, 12-month patient survival was 81.2%. The mean MELD score at OLT was 14.5±5.3 and 12-month survival with MELD >16 (71.7%) and <16 (86.2%) differed significantly (p=0.041). Predictors of 12-month mortality included age (53.2±9.4 versus 46.1±11.2 years; p=0.004), lower cholinesterase (2.9±1.88 versus 3.7±2.02 kU/l; p=0.026) and serum creatinine (160.4±186.8 versus 77.7±31.6 µmol/l; p=0.007), with creatinine and cholinesterase as independent parameters. Based on these parameters, a model for predicting patient survival after liver transplantation was calculated and validated in a second independent cohort of 87 OLT patients. This score identified a high-risk group and a low-risk group (overall survival 47.4 versus 91.2%; p<0.001) with a specificity of 87.3% and a sensitivity of 68.75%.

Conclusion. Age, pre-OLT creatinine and cholinesterase are predictors of short-term post-OLT survival and may be helpful as a bedside score in pre-OLT clinical management, outcome prediction and decision-making.

Keywords: Child-Turcotte-Pugh score; cholinesterase; cost; MELD; model of end-stage liver disease; 12-month survival

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