New scoring system may better predict liver transplant outcomes
Recipient factors such as advanced age, diabetes, haemodialysis status and ventilator use may help identify patients at risk of poor outcomes following liver transplantation, according to a recent US study.
Using multivariate analysis, researchers identified recipient factors associated with graft failure and assigned weight points: ventilator support (hazard ratio [HR], 1.59; 95 percent CI, 1.478–1.72; 5 points), age >60 years (HR, 1.29; 1.23–1.36; 3 points), haemodialysis (HR, 1.26; 1.16–1.37; 3 points), diabetes (HR, 1.20; 1.14–1.27; 2 points) and serum creatinine ≥1.5 mg/dL (HR, 1.15; 1.09–1.22; 2 points).
The point system showed a significant correlation with 5-year patient survival, such that those with lower points showed higher survival rates (0–4 points: 81.9 percent; 5–8 points: 72.1 percent; >8 points: 61.3 percent; p<0.001 for trend).
The same was true for graft survival. Those who earned only 0–4 points had the highest graft survival at 77.2 percent, while those who had 5–8 and >8 points showed graft survival rates of 69.1 percent and 57.9 percent, respectively. The greatest difference in graft survival was observed within the first year of transplantation (0–4 vs >8 points: 92 percent vs 75 percent; p<0.001).
“As our waitlisted population changes towards being sicker and having more comorbidities, our approach to transplant decisions also need to evolve,” said researchers.
“[O]bjective factors need to be re-evaluated that may help parse who may benefit most from deceased donor liver transplantation both from aspects of survival but also more within the realistic constraints of centre specific dynamics,” they added.
The present study included 31,829 transplanted patients without hepatitis C virus infection (median age 55 years; 41 percent female). In assigning weight points to the relevant recipient factors, researchers transformed the regression coefficients and used survival tree analysis to determine optimal cutoff values.