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Prediction of postoperative mortality in liver transplantation in the era of MELD-based liver allocation: a multivariate analysis.

Bruns H, Lozanovski VJ, Schultze D, Hillebrand N, Hinz U, Büchler MW, Schemmer P - PLoS ONE (2014)

Bottom Line: While waiting list mortality can be predicted by the MELD-score, reliable scoring systems for the postoperative period do not exist.With increasing number of these risk-factors, postoperative 90-day and 1-year mortality increased (0-1: 0 and 0%; 2: 2.9 and 17.4%; 3: 5.6 and 16.8%; 4: 22.2 and 33.3%; 5-6: 60.9 and 66.2%).Opening a discussion on the inclusion of these parameters in the process of organ allocation may be a worthwhile venture.

View Article: PubMed Central - PubMed

Affiliation: Department of General and Transplant Surgery, Ruprecht-Karls University, Heidelberg, Germany.

ABSTRACT

Background and aims: Liver transplantation is the only curative treatment for end-stage liver disease. While waiting list mortality can be predicted by the MELD-score, reliable scoring systems for the postoperative period do not exist. This study's objective was to identify risk factors that contribute to postoperative mortality.

Methods: Between December 2006 and March 2011, 429 patients underwent liver transplantation in our department. Risk factors for postoperative mortality in 266 consecutive liver transplantations were identified using univariate and multivariate analyses. Patients who were <18 years, HU-listings, and split-, living related, combined or re-transplantations were excluded from the analysis. The correlation between number of risk factors and mortality was analyzed.

Results: A labMELD ≥20, female sex, coronary heart disease, donor risk index >1.5 and donor Na+>145 mmol/L were identified to be independent predictive factors for postoperative mortality. With increasing number of these risk-factors, postoperative 90-day and 1-year mortality increased (0-1: 0 and 0%; 2: 2.9 and 17.4%; 3: 5.6 and 16.8%; 4: 22.2 and 33.3%; 5-6: 60.9 and 66.2%).

Conclusions: In this analysis, a simple score was derived that adequately identified patients at risk after liver transplantation. Opening a discussion on the inclusion of these parameters in the process of organ allocation may be a worthwhile venture.

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Related in: MedlinePlus

Box-Whisker-Plot depicting D-MELD scores for the number of positive risk factors in the patient collective.While there is an increase of median D-MELD-scores with an increasing number of risk factors, this is no significant correlation.
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pone-0098782-g003: Box-Whisker-Plot depicting D-MELD scores for the number of positive risk factors in the patient collective.While there is an increase of median D-MELD-scores with an increasing number of risk factors, this is no significant correlation.

Mentions: These factors were included in the risk score and patients were divided into subgroups according to the number of positive risk factors (Table 6, Figure 2). As the number of positive risk factors increases, there is an exponential hike in the 90-day mortality rates. Median D-MELD scores were 948.5 (IQR: 585.75–1673.5). Patients from both low (<1600) and high (≥1600) D-MELD groups had a median of 3 risk factors. While there was hike in the median D-MELD scores with an increase in the number of risk factors, no significant correlation could be detected between these two factors. Figure 3 illustrates this association between risk score and D-MELD. Moreover, while both the uni- and multivariate analyses indicated that the labMELD scores bore a significant influence, donor age was shown to have no impact on postoperative 90-day survival rates.


Prediction of postoperative mortality in liver transplantation in the era of MELD-based liver allocation: a multivariate analysis.

Bruns H, Lozanovski VJ, Schultze D, Hillebrand N, Hinz U, Büchler MW, Schemmer P - PLoS ONE (2014)

Box-Whisker-Plot depicting D-MELD scores for the number of positive risk factors in the patient collective.While there is an increase of median D-MELD-scores with an increasing number of risk factors, this is no significant correlation.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4048202&req=5

pone-0098782-g003: Box-Whisker-Plot depicting D-MELD scores for the number of positive risk factors in the patient collective.While there is an increase of median D-MELD-scores with an increasing number of risk factors, this is no significant correlation.
Mentions: These factors were included in the risk score and patients were divided into subgroups according to the number of positive risk factors (Table 6, Figure 2). As the number of positive risk factors increases, there is an exponential hike in the 90-day mortality rates. Median D-MELD scores were 948.5 (IQR: 585.75–1673.5). Patients from both low (<1600) and high (≥1600) D-MELD groups had a median of 3 risk factors. While there was hike in the median D-MELD scores with an increase in the number of risk factors, no significant correlation could be detected between these two factors. Figure 3 illustrates this association between risk score and D-MELD. Moreover, while both the uni- and multivariate analyses indicated that the labMELD scores bore a significant influence, donor age was shown to have no impact on postoperative 90-day survival rates.

Bottom Line: While waiting list mortality can be predicted by the MELD-score, reliable scoring systems for the postoperative period do not exist.With increasing number of these risk-factors, postoperative 90-day and 1-year mortality increased (0-1: 0 and 0%; 2: 2.9 and 17.4%; 3: 5.6 and 16.8%; 4: 22.2 and 33.3%; 5-6: 60.9 and 66.2%).Opening a discussion on the inclusion of these parameters in the process of organ allocation may be a worthwhile venture.

View Article: PubMed Central - PubMed

Affiliation: Department of General and Transplant Surgery, Ruprecht-Karls University, Heidelberg, Germany.

ABSTRACT

Background and aims: Liver transplantation is the only curative treatment for end-stage liver disease. While waiting list mortality can be predicted by the MELD-score, reliable scoring systems for the postoperative period do not exist. This study's objective was to identify risk factors that contribute to postoperative mortality.

Methods: Between December 2006 and March 2011, 429 patients underwent liver transplantation in our department. Risk factors for postoperative mortality in 266 consecutive liver transplantations were identified using univariate and multivariate analyses. Patients who were <18 years, HU-listings, and split-, living related, combined or re-transplantations were excluded from the analysis. The correlation between number of risk factors and mortality was analyzed.

Results: A labMELD ≥20, female sex, coronary heart disease, donor risk index >1.5 and donor Na+>145 mmol/L were identified to be independent predictive factors for postoperative mortality. With increasing number of these risk-factors, postoperative 90-day and 1-year mortality increased (0-1: 0 and 0%; 2: 2.9 and 17.4%; 3: 5.6 and 16.8%; 4: 22.2 and 33.3%; 5-6: 60.9 and 66.2%).

Conclusions: In this analysis, a simple score was derived that adequately identified patients at risk after liver transplantation. Opening a discussion on the inclusion of these parameters in the process of organ allocation may be a worthwhile venture.

Show MeSH
Related in: MedlinePlus