Prediction of Postoperative Mortality in Liver Transplantation in the Era of MELD-Based Liver Allocation: A Multivariate Analysis

Abstract

Background and AimsLiver 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.MethodsBetween 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.ResultsA 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%).ConclusionsIn 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.

Impact of acute‐on‐chronic liver failure on 90‐day mortality following a first liver transplantation

“…34 Finally, as in the case of hepatitis C and some other liver conditions, we observed a genderbased difference in post-transplant outcomes. 35 In the MELD era, our results agree with those of Bruns et al, 36 who found that a female donor was a strong and independent risk factor for 90-day post-LT mortality. The impact of donor gender on outcome has also been studied, but it is still necessary to clarify whether this is related to donor quality rather than donor gender per se, or a gender mismatch that actually impacts post-transplant outcome.…”

New‐onset diabetes after liver transplantation and its impact on complications and patient survival

“…By the end of 2012, data from the China Liver Transplant Registry, the national scientific registration system of liver transplantation in China, indicated that 23 560 patients had undergone liver transplantation . With developments in surgical techniques for liver transplantation, optimization of immunosuppressive regimens, and improvements in monitoring during the perioperative period, the incidence of postoperative acute rejection (AR) and other short‐term postoperative complications has been reduced considerably . Thus, short‐term survival has increased gradually.…”

“…3 With developments in surgical techniques for liver transplantation, optimization of immunosuppressive regimens, and improvements in monitoring during the perioperative period, the incidence of postoperative acute rejection (AR) and other short-term postoperative complications has been reduced considerably. 4 Thus, short-term survival has increased gradually. Nonetheless, long-term complications and quality of life after liver transplantation are attracting increasing attention.…”

Gender Mainstreaming and Transplant Surgery

“…In 2012, only one-third of liver graft recipients were female [8]. Current data determines a greater 90-day mortality for women with high MELD scores in Germany; in contrast, some studies showed a better outcome for female patients overall [8,15,33,34]. It is suspected that women are allocated for smaller and older organs associated with worse graft function, which does not affect survival [15,35].…”