Pretransplant Factors and Associations with Postoperative Respiratory Failure, ICU Length of Stay, and Short-Term Survival after Liver Transplantation in a High MELD Population

Pedersen, Mark; Choi, Myunghan; Brink, Jeffrey A.; Seetharam, Anil

doi:10.1155/2016/6787854

Cited by 14 publications

(12 citation statements)

References 18 publications

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“…Among the identified PRF risk factors, MELD at transplant, restrictive lung pattern and use of VVBP resulted the most relevant. The role of MELD [13,14,17] and restrictive lung pattern [16] has been previously evidenced. Notably, our study population includes two well-defined groups: high-MELD no-HCC patients and low-MELD HCC patients, and both groups have similar PRF prevalence.…”

Section: Discussionmentioning

confidence: 99%

Postoperative respiratory failure in liver transplantation: Risk factors and effect on prognosis

et al. 2019

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BackgroundPostoperative respiratory failure (PRF, namely mechanical ventilation >48 hours) significantly affects morbidity and mortality in liver transplantation (LTx). Previous studies analyzed only one or two categories of PRF risk factors (preoperative, intraoperative or postoperative ones).The aims of this study were to identify PRF predictors, to assess the length of stay (LoS) in ICU and the 90-day survival according to the PRF in LTx patients.MethodsTwo classification approaches were used: systematic classification (recipient-related preoperative factors; intraoperative factors; logistic factors; donor factors; postoperative ICU factors; postoperative surgical factors) and patient/organ classification (patient-related general factors; native-liver factors; new-liver factors; kidney factors; heart factors; brain factors; lung factors). Two hundred adult non-acute patients were included. Missing analysis was performed. The competitive role of each factor was assessed.ResultsPRF occurred in 36.0% of cases. Among 28 significant PRF predictors at univariate analysis, 6 were excluded because of collinearity, 22 were investigated by ROC curves and by logistic regression analysis. Recipient age (OR = 1.05; p = 0.010), female sex (OR = 2.75; p = 0.018), Model for End-Stage Liver Disease (MELD, OR = 1.09; p<0.001), restrictive lung pattern (OR = 2.49; p = 0.027), intraoperative veno-venous bypass (VVBP, OR = 3.03; p = 0.008), pre-extubation PaCO2 (OR = 1.11; p = 0.003) and Model for Early Allograft Function (MEAF, OR = 1.37; p<0.001) resulted independent PRF risk factors. As compared to patients without PRF, the PRF-group had longer LoS (10 days IQR 7–18 versus 5 days IQR 4–7, respectively; p<0.001) and lower day-90 survival (86.0% versus 97.6% respectively, p<0.001).ConclusionIn conclusion, MELD, restrictive lung pattern, surgical complexity as captured by VVBP, pre-extubation PaCO2 and MEAF are the main predictors of PRF in non-acute LTx patients.

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Section: Discussionmentioning

confidence: 99%

Postoperative respiratory failure in liver transplantation: Risk factors and effect on prognosis

et al. 2019

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“…Length of stay following liver transplantation is currently coming into focus. Several recent studies have identified predictors of prolonged length of stay and have used length of stay as a surrogate for healthcare expenditures …”

Section: Introductionmentioning

confidence: 99%

Liver transplant length of stay (LOS) index: A novel predictive score for hospital length of stay following liver transplantation

Rana

Witte

Halazun

et al. 2017

Clinical Transplantation

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An index to predict hospital length of stay after liver transplantation could address unmet clinical needs. Length of stay is an important surrogate for hospital costs and efforts to limit stays can preserve our healthcare resources. Here, we devised a scoring system that predicts hospital length of stay following liver transplantation. We used univariate and multivariate analyses on 73 635 adult liver transplant recipient data and identified independent recipient and donor risk factors for prolonged hospital stay (>30 days). Multiple imputation was used to account for missing variables. We identified 22 factors as significant predictors of prolonged hospital stay, including the most significant risk factors: intensive care unit (ICU) admission (OR 1.75, CI 1.58-1.95) and previous transplant (OR 1.60, CI 1.47-1.75). The length of stay (LOS) index assigns weighted risk points to each significant factor in a scoring system to predict prolonged hospital stay after liver transplantation with a c-statistic of 0.75. The LOS index demonstrated good discrimination across the entire population, dividing the cohort into tertiles, which had odds ratios of 2.25 (CI 2.06-2.46) and 7.90 (7.29-8.56) for prolonged hospital stay (>30 days). The LOS index utilizes 22 significant donor and recipient factors to accurately predict hospital length of stay following liver transplantation. The index further demonstrates the basis for a clear clinical recommendation to mitigate risk of long hospitalization by minimizing cold ischemia time.

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“…Recently, benchmark 16 indicators have been described regarding outcomes after liver transplant, including surgical outcomes, patient and graft survival, patient care in the ICU, complications, length of stay, and other factors. Regarding length of stay in the ICU, Pedersen and associates, 17 in a study of factors associated with a longer stay in the ICU, found that pretransplant MELD was the most potent predictor of prolonged ICU stay. Stratigopoulou and colleagues 18 confirmed that MELD and transplant duration are independent predictors of prolonged ICU stay.…”

Section: Discussionmentioning

confidence: 99%

Graft Risk Index After Liver Transplant: Internal and External Validation of a New Spanish Indicator

Burdio¹,

Buil²,

Lopez³

et al. 2019

Exp Clin Transplant

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Objectives: Scarcity of liver grafts has led to the use of marginal donors, consequently increasing the number of complications posttransplant. To prevent this situation, several indicators have been developed. However, important differences remain among countries. Here, we compared an early-risk liver transplant indicator based on the Spanish Liver Transplant Registry, called the Graft Risk Index, versus the US donor risk index and the Eurotransplant donor risk index. Materials and Methods: The new indicator was based on prospectively collected data from 600 adult liver transplants performed in our center. We considered 2 events to compare the indexes: graft survival and rejection-free graft survival, with Cox proportional regression for analyses. Power to predict graft survival was evaluated by calculating the receiver operating characteristic area under the curve. Results: We found no differences between the US and Eurotransplant donor risk indexes in prediction of patients with and without early graft failure. With regard to early survival, only the Graft Risk Index allowed better survival discrimination, in which survival progressively decreased with values ≥ 3 (with probability of graft survival at 1 month of 68%; 95% confidence interval, 46.2-82.5). This increase in risk was significant compared with the standard group (hazard ratio of 10.15; 95% confidence interval, C 3.91-26.32; P < .001). We calculated powers of prediction of 0.52 (95% confidence interval, 0.43-0.62), 0.54 (95% confidence interval, 0.45-0.65), and 0.69 (95% confidence interval, 0.61-0.77) for donor risk index, Eurotransplant donor risk index, and early Graft Risk Index, respectively. Conclusions: Neither the US donor risk index nor the Eurotransplant donor risk index was valid for our Spanish liver donation and transplant program. Therefore, an indicator to predict posttransplant graft survival that is adapted to our environment is necessary. This national Graft Risk Index can be a useful tool to optimize donor-recipient matching.

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Pretransplant Factors and Associations with Postoperative Respiratory Failure, ICU Length of Stay, and Short-Term Survival after Liver Transplantation in a High MELD Population

Cited by 14 publications

References 18 publications

Postoperative respiratory failure in liver transplantation: Risk factors and effect on prognosis

Postoperative respiratory failure in liver transplantation: Risk factors and effect on prognosis

Liver transplant length of stay (LOS) index: A novel predictive score for hospital length of stay following liver transplantation

Graft Risk Index After Liver Transplant: Internal and External Validation of a New Spanish Indicator

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