Mortality after liver transplantation depends on heterogeneous recipient and donor factors.
Dr Andrew Burroughs and colleagues assessed risk of death and to develop models to help predict mortality after liver transplantation.
The research team analyzed data from 34,664 first adult liver transplants from the European Liver Transplant Registry.
The researchers identified factors associated with mortality at 3-months, and 12-months after transplantation.
The team used multivariable logistic regression models to generate mortality scores for each individual.
Model discrimination and calibration on an independent validation dataset was assessed.
|Increased mortality at 3-months post-transplantation was associated with acute liver failure|
The team found that 12% of individuals in the 3-month training sample had died by 3 months.
Compared with those transplanted in 2000 to 2003, those transplanted earlier had a higher risk of death.
The researchers observed that increased mortality at 3-months post-transplantation was associated with acute liver failure.
Donor age older than 60 years, compatible or incompatible donor-recipient blood group, and older recipient age were also associated with acute liver failure.
In addition, liver failure was associated with split or reduced graft, total ischemia time of longer than 13 hours, and low United Network for Organ Sharing score.
However, cirrhosis with hepatocellular carcinoma, alcohol cirrhosis, Hepatitis C or primary biliary cirrhosis were associated with improved early outcomes.
The team noted that donor age 40 years or younger, Hepatitis B, and larger size of transplant center were also associated with improved early outcomes.
The 3-month mortality score discriminated well between those who did and did not die in the validation sample.
The researchers noted similar findings for 12-month mortality, although deaths were generally underestimated at this timepoint.
Dr Burroughs concludes, “The 3-month and 12-month mortality models can be effectively used to assess outcomes both within and between centers.”
“Furthermore, the models provide a means of assessing the risk of post-transplantation mortality, giving clinicians important data on which to base strategic decisions about transplant policy in particular individuals or groups.”