Scoring Systems for Predicting Mortality after Liver Transplantation

Abstract

BackgroundLiver transplantation can prolong survival in patients with end-stage liver disease. We have proposed that the Sequential Organ Failure Assessment (SOFA) score calculated on post-transplant day 7 has a great discriminative power for predicting 1-year mortality after liver transplantation. The Chronic Liver Failure - Sequential Organ Failure Assessment (CLIF-SOFA) score, a modified SOFA score, is a newly developed scoring system exclusively for patients with end-stage liver disease. This study was designed to compare the CLIF-SOFA score with other main scoring systems in outcome prediction for liver transplant patients.MethodsWe retrospectively reviewed medical records of 323 patients who had received liver transplants in a tertiary care university hospital from October 2002 to December 2010. Demographic parameters and clinical characteristic variables were recorded on the first day of admission before transplantation and on post-transplantation days 1, 3, 7, and 14.ResultsThe overall 1-year survival rate was 78.3% (253/323). Liver diseases were mostly attributed to hepatitis B virus infection (34%). The CLIF-SOFA score had better discriminatory power than the Child-Pugh points, Model for End-Stage Liver Disease (MELD) score, RIFLE (risk of renal dysfunction, injury to the kidney, failure of the kidney, loss of kidney function, and end-stage kidney disease) criteria, and SOFA score. The AUROC curves were highest for CLIF-SOFA score on post-liver transplant day 7 for predicting 1-year mortality. The cumulative survival rates differed significantly for patients with a CLIF-SOFA score ≤8 and those with a CLIF-SOFA score >8 on post-liver transplant day 7.ConclusionThe CLIF-SOFA score can increase the prediction accuracy of prognosis after transplantation. Moreover, the CLIF-SOFA score on post-transplantation day 7 had the best discriminative power for predicting 1-year mortality after liver transplantation.

Use of Renal Replacement Therapy May Influence Graft Outcomes following Liver Transplantation for Acute Liver Failure: A Propensity-Score Matched Population-Based Retrospective Cohort Study

“…In contrast we did not demonstrate the presence of pre-operative RRT significantly reduced patient mortality following liver transplantation for ALF. This finding has been replicated previously in observational studies [ 28 ]. Other pre- and post-operative factors are likely to contribute to patient survival, with evidence suggesting response to various therapeutic strategies at day 7 post-transplantation (such as oxygen saturation, hypotension and level of inotropic support) predict survival [ 29 , 30 ].…”

“…As a result, the presence of RRT may have an additive effect on patient mortality in the presence of other organ support systems but may explain why it does not independently predict patient mortality. However, evidence suggests that the same patient cohort also has a higher rate of acute rejection and hence graft failure [ 28 ]. RRT may therefore provide an important, currently unidentified, individual mechanism in reducing graft failure compared to other organ support systems (as discussed previously) that would explain the effect of RRT in improving graft survival in this study.…”

“…Unfortunately data were not available for patient baseline renal function prior to development of acute liver failure, and despite attempting to account for confounding factors with propensity-score matching, an element of confounding may remain in the form of RRT indication, timing and modality, which is known to be diverse in clinical practice [ 35 ]. Furthermore pre- and post-operative Sequential Organ Failure Assessment (SOFA) and Model for End-Stage Liver Disease (MELD) scores, known to accurately predict short-term prognosis in liver transplantation [ 28 ], are not available within the dataset. This may limit the generalization of our findings.…”

Proteinuria can predict prognosis after liver transplantation

“…Severity of liver disease was assessed by CP points and MELD score [ 14 , 15 ]. Severity of illness was also graded by SOFA score according to the six organ systems.…”

Reply to “Is the post-transplant survival the unique Holy Grail?”

“…While there is no doubt that the care of critically ill patients with end-stage liver disease (ESLD) has improved with time [5,6], perhaps in part due to better diagnostic and prognostic scoring systems such as the CLIF scores [7,8], this unfortunately does not help answer what additional risks are assumed when transplanting waitlisted candidates from the intensive care unit (ICU). One single-center study by Pan et al has demonstrated that some CLIF scores on admission can predict in-hospital and 1-year mortality post-transplant [9], however larger studies are needed to confirm this finding. Furthermore, while helpful in research, these scoring systems are not widely used in the day-to-day evaluation of inpatient transplant candidates, where the ultimate decision remains center based and primarily driven by anecdotal experience.…”