3-month & 12-month mortality after liver transplant in Europe: predictive models for outcome.

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Lancet.

2006 Jan 21.

3-month

and 12-month mortality after first liver transplant in adults in Europe: predictive models for

outcome.

Burroughs

AK, Sabin

CA, Rolles

K, Delvart

V, Karam

V, Buckels

J, O'Grady

JG, Castaing

D, Klempnauer

J, son

N, Neuhaus

P, Lerut

J, de

Ville de Goyet J, Pollard

S, Salizzoni

M, Rogiers

X, Muhlbacher

F,

Valdecasas JC, Broelsch

C, Jaeck

D, Berenguer

J,

EM, Adam

R; European

Liver Transplant Association.

Liver Transplantation & Hepatobiliary

Medicine, Royal Free Hampstead NHS Trust, London, UK.

BACKGROUND: Mortality after liver transplantation depends on heterogeneous

recipient and donor factors. Our aim was to assess risk of death and to develop

models to help predict mortality after liver transplantation. METHODS: We analysed data from 34,664 first adult liver transplants

from the European Liver Transplant Registry to identify factors associated with

mortality at 3-months (n=21,605 in training dataset) and 12-months (n=18,852 in

training dataset) after transplantation. We used multivariable logistic

regression models to generate mortality scores for each individual, and

assessed model discrimination and calibration on an independent validation

dataset (n=9489 for 3-month model and n=8313 for 12-month model). FINDINGS:

2540 of 21,605 (12%) individuals in the 3-month training sample had died by 3

months. Compared with those transplanted in 2000-03, those transplanted earlier

had a higher risk of death. Increased mortality at 3-months

post-transplantation was associated with acute liver failure (adjusted odds

ratio 1.61), donor age older than 60 years (1.16), compatible (1.22) or

incompatible (2.07) donor-recipient blood group, older recipient age (1.12 per

5 years), split or reduced graft (1.96), total ischaemia

time of longer than 13 h (1.38), and low United Network for Organ Sharing score

(score 1: 2.43; score 2: 1.67). However, cirrhosis with hepatocellular

carcinoma, alcohol cirrhosis, hepatitis C or primary biliary cirrhosis, donor

age 40 years or younger, or less, hepatitis B, and larger size of transplant

centre (> or = 70 transplants per year) were associated with improved early

outcomes. The 3-month mortality score discriminated well between those who did

and did not die in the validation sample (C statistic=0.688). We noted similar

findings for 12-month mortality, although deaths were generally underestimated

at this timepoint. INTERPRETATION: The 3-month and 12-month mortality models can

be effectively used to assess outcomes both within and between centres. 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.

PMID: 16427491 [PubMed - in process]

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