Prognostic value of preoperatively obtained clinical and laboratory data in predicting survival following orthotopic liver transplantation

Abstract

Twenty-seven clinical and laboratory data and the subsequent clinical course of 93 consecutive adult patients who underwent orthotopic liver transplantation for various chronic advanced liver diseases were analyzed retrospectively to assess the risk factors of early major bacterial infection and death after the procedure. Forty-one patients (44%) had early major bacterial infection during hospitalization for orthotopic liver transplantation. The mortality rate was 70.7% in patients with early major bacterial infection and was 7.7% in patients without early major bacterial infection (p < 0.001). Total serum bilirubin, total white blood cell count and polymorphonuclear cell count, IgG (all p < 0.05) and plasma creatinine level (p < 0.001) were higher in patients that developed early major bacterial infection than in those who did not. By step-wise discriminant analysis, the strongest risk factor for early major bacterial infection was the serum creatinine level, which achieved an accuracy of 69% for a creatinine level greater than 1.58 mg per dl.Seven variables (ascites, hepatic encephalopathy, elevated white blood and polymorphonuclear cell count, decreased helper to suppressor T cell ratio and elevated plasma creatinine and bilirubin levels) were associated with a significant increased risk for death. A step-wise discriminant analysis of these seven factors resulted in the demonstration of serum creatinine as the greatest risk factor for mortality. A preoperative serum creatinine either less than or greater than 1.72 mg per dl accurately predicts survival or death, respectively, in 79% of cases. These data suggest that the baseline preoperative serum creatinine level provides the best indication of the short-term prognosis after liver transplantation than does any other preoperatively obtained index of the patient's status.Orthotopic liver transplantation (OLTx) has dramatically altered the otherwise fatal outcome for some patients with advanced chronic liver disease and has been reported to obtain a 70.8% survival in adult patients at 1 year after OLTx (1). Because both economic and human resources are limited within the health care system of most countries and institutions, liver transplantation ideally should be restricted to those patients with the greatest possibility of survival after the procedure, so the selection of appropriate candidates for OLTx has become an issue of considerable concern both for physicians and surgeons involved in the management of patients with advanced hepatic disease.In a recent series of adult patients with OLTx, 75% of the deaths occurred during the first 60 days post-transplantation (2). In this series, infectious complications were the most common cause of death. Ninety percent of the deaths due to infection following OLTx occurred during NIH Public Access Author ManuscriptHepatology. Author manuscript; available in PMC 2010 November 8. Published in final edited form as:Hepatology. 1986 ; 6(5): 922-927. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author M...

Pretransplant renal function predicts survival in patients undergoing orthotopic liver transplantation

“…1,3,7,12,13 However, a previous study that classified non-HRS renal failure into 4 groups (mean glomerular filtration rate [GFR] in the 4 groups ranging from 47 to 140 mL/min) reported that there was no difference in patient survival between the different groups. 2 The discrepant results of this study, contrary to our findings, could be explained by the small sample size; more importantly, the patients were divided into 4 groups based on GFR obtained at the time of initial liver transplant evaluation.…”

“…[5][6][7][8] In addition, use of immunosuppressants such as cyclosporine and tacrolimus may cause further deterioration in renal function in this population. [7][8][9][10] Preoperative serum creatinine levels have been shown to be an important predictor of postoperative sepsis, 11,12 number of days spent in the intensive care unit, 3,13 need for preoperative and postoperative dialysis, 2,13 overall cost of liver transplantation, 13,14 and short-term graft and patient survival rates. 1,7,8,11,12,15 In one study, 2-year patient and graft survival rates were found to be similar in 31 patients with HRS and 263 without HRS.…”

Identification of patients best suited for combined liver[ndash ]kidney transplantation: Part II

“…2,[8][9][10][11][12][13][14][15][16][17][18][19] Even mild elevations in serum creatinine level to greater than 1.0 to 1.6 mg/dL have predicted an increased incidence of post-OLT dialysis and death. 8,13,15,[19][20][21][22] Mortality is particularly common in patients with fulminant hepatic failure (FHF) and renal insufficiency. 21,23 Mortality seems to be explained by the serious medical condition of patients developing ARF, evidenced by their higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores (16 Ϯ 0.4 without ARF v 23.2 Ϯ 0.8 with ARF) and number of associated medical illnesses compared with those without renal failure.…”

Liver transplantation for alcoholic liver disease: Evaluation of a selection protocol

“…28,29 involves balancing the risk of procedure against the patient's probability of surviving without this treatment. While sevTo use a model derived from patients who did not receive transplants suggests a benefit from transplantation, must be eral factors, predictive of poor post-operative outcome, have been described, 25,26 predicting the prognosis of ALD in terms done with considerable caution. The group from which the model was derived and the patients who received transplants of survival without transplantation is a much more difficult problem.…”