In this study, investigators from Spain reviewed their liver transplant performance to identify factors influencing outcomes.
The team examined the clinical records of 190 patients who had liver transplants performed between 1991 and 1997. The prognostic model obtained was prospectively evaluated in 55 patients undergoing transplant between 1999 and 2000.
|No donor factors were significant.|
Main indication for transplant was post-necrotic cirrhosis, and the majority of patients were Child-Pugh C status.
The investigators found that post-operative mortality at 3 months was 15%. They identified the risk factors predicting death as Child-Pugh C status (OR 1.3), pre-liver transplant renal insufficiency (OR 5.8), malnutrition (OR 2.9), and technically complex surgery requiring cross-clamping (OR 4.9).
They did not find that any of the donor factors were significant.
When the model was prospectively applied it had a sensitivity of 80% and a specificity of 89%. It also had a positive predictive value of 62% and a negative predictive value of 95%.
Dr Itxarone Bilbao's team concluded, "Pre-liver transplantation renal insufficiency is the most significant risk factor for early mortality".
"Liver transplantation should be performed before evidence of irreversible renal insufficiency becomes manifest".