Predictive factors for early mortality following liver transplantation

Bilbao, Itxarone; Armadans, Luis; Lázaro, José; Hidalgo, Ernest; Castells, Lluı́s; Margarit, C

doi:10.1034/j.1399-0012.2003.00068.x

Cited by 66 publications

(59 citation statements)

References 35 publications

(43 reference statements)

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“…These variables are consistent with the findings in other cohorts (5,7,10,14,15,20,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). As for RD certain malignancies (HCC beyond Milan (35) and advanced cholangiocarcinomas (36)) are no longer indications for LT.…”

Section: Discussionsupporting

confidence: 88%

Twenty-Year Longitudinal Follow-Up After Orthotopic Liver Transplantation: A Single-Center Experience of 313 Consecutive Cases

Schoening

Buescher

Rademacher

et al. 2013

American Journal of Transplantation

107

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y These authors have contributed equally to this work.With excellent short-term survival in liver transplantation (LT), we now focus on long-term outcome and report the first European single-center 20-year survival data. Three hundred thirty-seven LT were performed in 313 patients (09/88-12/92). Impact on long-term outcome was studied and a comparison to life expectancy of matched normal population was performed. A detailed analysis of 20-years follow-up concerning overweight (HBMI), hypertension (HTN), diabetes (HGL), hyperlipidemia (HLIP) and moderately or severely impaired renal function (MIRF, SIRF) is presented. Patient and graft survival at 1, 10, 20 years were 88.4%, 72.7%, 52.5% and 83.7%, 64.7% and 46.6%, respectively. Excluding 1-year mortality, survival in the elderly LT recipients was similar to normal population. Primary indication (p < 0.001), age (p < 0.001), gender (p ¼ 0.017), impaired renal function at 6 months (p < 0.001) and retransplantation (p ¼ 0.034) had significant impact on patient survival. Recurrent disease (21.3%), infection (20.6%) and de novo malignancy (19.9%) were the most common causes of death. Prevalence of .2%, p < 0.001), p ¼ 0.01) and HBMI (33.2-45%, p ¼ 0.014) increased throughout follow-up, while prevalence of HLIP (78.0-47.6%, p < 0.001) declined. LT has conquered many barriers to achieve these outstanding long-term results. However, much work is needed to combat recurrent disease and side effects of immunosuppression (IS).

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Section: Discussionsupporting

confidence: 88%

Twenty-Year Longitudinal Follow-Up After Orthotopic Liver Transplantation: A Single-Center Experience of 313 Consecutive Cases

Schoening

Buescher

Rademacher

et al. 2013

American Journal of Transplantation

107

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“…Many authors have reported models for predicting postliver transplantation survival and these models are mostly influenced by pretransplant recipient factors such as chronic renal failure, recipient age and body mass index (18)(19)(20). These factors are mostly unrelated to the direct complications of cirrhosis and are more related to the general state of health of the individual recipient.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Delta-MELD Score Does Not Independently Predict Mortality After Liver Transplantation

Berg

2004

American Journal of Transplantation

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Changes in model for end-stage liver disease (MELD) score of ≥5 points over 30 days (delta-MELD) is an independent predictor for death in patients awaiting liver transplantation. The aim of the current study was to determine if a positive change in MELD score occurring over the 30 days immediately prior to liver transplantation was predictive of posttransplant mortality. MELD scores from the day of transplantation and 30 days prior to transplantation were calculated for 1510 UNOS patients and used to compute a delta-MELD score. Multivariate modeling determined predictors of posttransplant mortality. Patients with a preoperative delta-MELD ≥ 5 had higher absolute MELD scores at transplant, shorter mean posttransplant survival and higher mortality. However, multivariate analysis showed that none of the excess mortality was attributable to the high delta-MELD score (p = 0.43 for delta-MELD ≥ 5) and the majority of the excess risk was attributable to absolute MELD score (p < 0.001) at the time of transplantation. Mortality of patients with rapidly worsening chronic liver disease who undergo transplantation depends substantially on absolute MELD score at the time of transplantation but not the rate of change immediately preceding transplant. Allocation policymakers should consider that a high delta-MELD in the immediate pretransplant period does not indicate greater posttransplant mortality.

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“…A handful of previous relatively small observational studies had demonstrated a correlation between recipient hyponatremia and post-transplant mortality [28,29,30]. However, an equivalent number of similar quality studies have challenged this notion [31,32,33].…”

Section: Impact Of Hyponatremia On Post-transplant Outcomesmentioning

confidence: 99%

Implications of Hyponatremia in Liver Transplantation

Çimen

Güler

Ayloo

et al. 2014

JCM

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Although there are a limited number of quality studies, appropriate peri-operative management of serum electrolytes seems to reduce adverse outcomes in liver transplantation. Hyponatremia is defined as the presence of serum concentration of sodium equal ≤130 mmol/L and it is detected in approximately 20% of patients with end stage liver disease waiting for a liver transplant (LT). This paper will focus on the pathogenesis of dilutional hyponatremia and its significance in terms of both candidacy for LT and post-operative outcomes.

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Predictive factors for early mortality following liver transplantation

Abstract: Pre-LT renal insufficiency is the most significant risk factor for early mortality and suggests that LT should be performed before evidence of irreversible renal insufficiency becomes manifest.

Cited by 66 publications

References 35 publications

Twenty-Year Longitudinal Follow-Up After Orthotopic Liver Transplantation: A Single-Center Experience of 313 Consecutive Cases

Twenty-Year Longitudinal Follow-Up After Orthotopic Liver Transplantation: A Single-Center Experience of 313 Consecutive Cases

Preoperative Delta-MELD Score Does Not Independently Predict Mortality After Liver Transplantation

Implications of Hyponatremia in Liver Transplantation

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