TY - JOUR
T1 - Recipient characteristics and morbidity and mortality after liver transplantation
AU - Asrani, Sumeet K.
AU - Saracino, Giovanna
AU - O'Leary, Jacqueline G.
AU - Gonzales, Stevan
AU - Kim, Peter T.
AU - McKenna, Greg J.
AU - Klintmalm, Goran
AU - Trotter, James
N1 - Funding Information:
“The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government”.
Publisher Copyright:
© 2018 European Association for the Study of the Liver
PY - 2018/7
Y1 - 2018/7
N2 - Background and Aims: Over the last decade, liver transplantation of sicker, older non-hepatitis C cirrhotics with multiple co-morbidities has increased in the United States. We sought to identify an easily applicable set of recipient factors among HCV negative adult transplant recipients associated with significant morbidity and mortality within five years after liver transplantation. Methods: We collected national (n = 31,829, 2002–2015) and center-specific data. Coefficients of relevant recipient factors were converted to weighted points and scaled from 0–5. Recipient factors associated with graft failure included: ventilator support (five patients; hazard ratio [HR] 1.59; 95% CI 1.48–1.72); recipient age >60 years (three patients; HR 1.29; 95% CI 1.23–1.36); hemodialysis (three patients; HR 1.26; 95% CI 1.16–1.37); diabetes (two patients; HR 1.20; 95% CI 1.14–1.27); or serum creatinine ≥1.5 mg/dl without hemodialysis (two patients; HR 1.15; 95% CI 1.09–1.22). Results: Graft survival within five years based on points (any combination) was 77.2% (0–4), 69.1% (5–8) and 57.9% (>8). In recipients with >8 points, graft survival was 42% (model for end-stage liver disease [MELD] score <25) and 50% (MELD score 25–35) in recipients receiving grafts from donors with a donor risk index >1.7. In center-specific data within the first year, subjects with ≥5 points (vs. 0–4) had longer hospitalization (11 vs. 8 days, p <0.01), higher admissions for rehabilitation (12.3% vs. 2.7%, p <0.01), and higher incidence of cardiac disease (14.2% vs. 5.3%, p <0.01) and stage 3 chronic kidney disease (78.6% vs. 39.5%, p = 0.03) within five years. Conclusion: The impact of co-morbidities in an MELD-based organ allocation system need to be reassessed. The proposed clinical tool may be helpful for center-specific assessment of risk of graft failure in non-HCV patients and for discussion regarding relevant morbidity in selected subsets. Lay summary: Over the last decade, liver transplantation of sicker, older patient with multiple co-morbidities has increased. In this study, we show that a set of recipient factors (recipient age >60 years, ventilator status, diabetes, hemodialysis and creatinine >1.5 mg/dl) can help identify patients that may not do well after transplant. Transplanting sicker organs in patients with certain combinations of these characteristics leads to lower survival.
AB - Background and Aims: Over the last decade, liver transplantation of sicker, older non-hepatitis C cirrhotics with multiple co-morbidities has increased in the United States. We sought to identify an easily applicable set of recipient factors among HCV negative adult transplant recipients associated with significant morbidity and mortality within five years after liver transplantation. Methods: We collected national (n = 31,829, 2002–2015) and center-specific data. Coefficients of relevant recipient factors were converted to weighted points and scaled from 0–5. Recipient factors associated with graft failure included: ventilator support (five patients; hazard ratio [HR] 1.59; 95% CI 1.48–1.72); recipient age >60 years (three patients; HR 1.29; 95% CI 1.23–1.36); hemodialysis (three patients; HR 1.26; 95% CI 1.16–1.37); diabetes (two patients; HR 1.20; 95% CI 1.14–1.27); or serum creatinine ≥1.5 mg/dl without hemodialysis (two patients; HR 1.15; 95% CI 1.09–1.22). Results: Graft survival within five years based on points (any combination) was 77.2% (0–4), 69.1% (5–8) and 57.9% (>8). In recipients with >8 points, graft survival was 42% (model for end-stage liver disease [MELD] score <25) and 50% (MELD score 25–35) in recipients receiving grafts from donors with a donor risk index >1.7. In center-specific data within the first year, subjects with ≥5 points (vs. 0–4) had longer hospitalization (11 vs. 8 days, p <0.01), higher admissions for rehabilitation (12.3% vs. 2.7%, p <0.01), and higher incidence of cardiac disease (14.2% vs. 5.3%, p <0.01) and stage 3 chronic kidney disease (78.6% vs. 39.5%, p = 0.03) within five years. Conclusion: The impact of co-morbidities in an MELD-based organ allocation system need to be reassessed. The proposed clinical tool may be helpful for center-specific assessment of risk of graft failure in non-HCV patients and for discussion regarding relevant morbidity in selected subsets. Lay summary: Over the last decade, liver transplantation of sicker, older patient with multiple co-morbidities has increased. In this study, we show that a set of recipient factors (recipient age >60 years, ventilator status, diabetes, hemodialysis and creatinine >1.5 mg/dl) can help identify patients that may not do well after transplant. Transplanting sicker organs in patients with certain combinations of these characteristics leads to lower survival.
KW - Futility
KW - Liver transplantation
KW - Morbidity
KW - Mortality
KW - Outcomes
KW - Risk score
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U2 - 10.1016/j.jhep.2018.02.004
DO - 10.1016/j.jhep.2018.02.004
M3 - Article
C2 - 29454069
AN - SCOPUS:85044946713
SN - 0168-8278
VL - 69
SP - 43
EP - 50
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 1
ER -