A group of researchers from Pennsylvania and California, USA, retrospectively reviewed consecutive liver transplants performed at the University of California at Los Angeles during a 6-year period. They determined the preoperative variables that were associated with outcome in primary grafts.
In addition, the hospital's cost accounting database was used to determine the impact of these variables on the degree of resource use by high-risk patients.
|Variables associated with graft survival:|
- Donor age
- Recipient age
- Donor sodium
- Recipient creatinine
- Recipient ventilator requirement
The researchers found 5 variables to have independent prognostic value in predicting graft survival after primary liver transplantation. These were donor age, recipient age, donor sodium, recipient creatinine, and recipient ventilator requirement pre-transplant.
Recipient ventilator requirement and elevated creatinine were associated with significant increases in resource use during the transplant admission.
James F. Markmann, of the Hospital of the University of Pennsylvania, Philadelphia, and colleagues, concluded from their study that patients at high risk for graft failure and costly transplants can be identified preoperatively by a set of parameters that are readily available, noninvasive, and inexpensive.
Selection of recipients on the basis of these data would improve the efficiency of liver transplantation and reduce its cost, they added.