Recipient characteristics and morbidity and mortality after liver transplantation

Sumeet K. Asrani, Giovanna Saracino, Jacqueline G. O'Leary, Stevan Gonzales, Peter T. Kim, Greg J. McKenna, Goran Klintmalm, James Trotter

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
JournalJournal of Hepatology
DOIs
StateAccepted/In press - Jan 1 2018

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Liver Transplantation
Morbidity
Mortality
Renal Dialysis
Graft Survival
Mechanical Ventilators
Creatinine
Transplants
End Stage Liver Disease
Hospitalization
Survival
Serum

Keywords

  • Futility
  • Liver transplantation
  • Morbidity
  • Mortality
  • Outcomes
  • Risk score

ASJC Scopus subject areas

  • Hepatology

Cite this

Asrani, S. K., Saracino, G., O'Leary, J. G., Gonzales, S., Kim, P. T., McKenna, G. J., ... Trotter, J. (Accepted/In press). Recipient characteristics and morbidity and mortality after liver transplantation. Journal of Hepatology. https://doi.org/10.1016/j.jhep.2018.02.004

Recipient characteristics and morbidity and mortality after liver transplantation. / Asrani, Sumeet K.; Saracino, Giovanna; O'Leary, Jacqueline G.; Gonzales, Stevan; Kim, Peter T.; McKenna, Greg J.; Klintmalm, Goran; Trotter, James.

In: Journal of Hepatology, 01.01.2018.

Research output: Contribution to journalArticle

Asrani, Sumeet K. ; Saracino, Giovanna ; O'Leary, Jacqueline G. ; Gonzales, Stevan ; Kim, Peter T. ; McKenna, Greg J. ; Klintmalm, Goran ; Trotter, James. / Recipient characteristics and morbidity and mortality after liver transplantation. In: Journal of Hepatology. 2018.
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title = "Recipient characteristics and morbidity and mortality after liver transplantation",
abstract = "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.",
keywords = "Futility, Liver transplantation, Morbidity, Mortality, Outcomes, Risk score",
author = "Asrani, {Sumeet K.} and Giovanna Saracino and O'Leary, {Jacqueline G.} and Stevan Gonzales and Kim, {Peter T.} and McKenna, {Greg J.} and Goran Klintmalm and James Trotter",
year = "2018",
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day = "1",
doi = "10.1016/j.jhep.2018.02.004",
language = "English (US)",
journal = "Journal of Hepatology",
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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

PY - 2018/1/1

Y1 - 2018/1/1

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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