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. 2014 Jun 6;9(6):e98782.
doi: 10.1371/journal.pone.0098782. eCollection 2014.

Prediction of postoperative mortality in liver transplantation in the era of MELD-based liver allocation: a multivariate analysis

Helge Bruns  1 , Vladimir J Lozanovski  1 , Daniel Schultze  1 , Norbert Hillebrand  1 , Ulf Hinz  1 , Markus W Büchler  1 , Peter Schemmer  1
Affiliations

Prediction of postoperative mortality in liver transplantation in the era of MELD-based liver allocation: a multivariate analysis

Helge Bruns et al. PLoS One. .

Abstract

Background and aims: Liver transplantation is the only curative treatment for end-stage liver disease. While waiting list mortality can be predicted by the MELD-score, reliable scoring systems for the postoperative period do not exist. This study's objective was to identify risk factors that contribute to postoperative mortality.

Methods: Between December 2006 and March 2011, 429 patients underwent liver transplantation in our department. Risk factors for postoperative mortality in 266 consecutive liver transplantations were identified using univariate and multivariate analyses. Patients who were <18 years, HU-listings, and split-, living related, combined or re-transplantations were excluded from the analysis. The correlation between number of risk factors and mortality was analyzed.

Results: A labMELD ≥20, female sex, coronary heart disease, donor risk index >1.5 and donor Na+>145 mmol/L were identified to be independent predictive factors for postoperative mortality. With increasing number of these risk-factors, postoperative 90-day and 1-year mortality increased (0-1: 0 and 0%; 2: 2.9 and 17.4%; 3: 5.6 and 16.8%; 4: 22.2 and 33.3%; 5-6: 60.9 and 66.2%).

Conclusions: In this analysis, a simple score was derived that adequately identified patients at risk after liver transplantation. Opening a discussion on the inclusion of these parameters in the process of organ allocation may be a worthwhile venture.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Patient Allocation.
Of 429 patients who underwent liver transplantation at our institution from December 2006 till March 2011, 266 were eligible for inclusion in the study. *incl. 18 HU-listed, 33 split/living related, and 5 retransplantations; excl. **<18 years; ***<18 years or HU-listed; ****<18 years, HU-listed or split/living related or combined organ transplantation.
Figure 2
Figure 2. Survival stratified for number of positive risk factors.
With an increasing number of risk-factors, postoperative 90-day and 1-year mortality increased (0–1: 0 and 0%; 2: 2.9 and 17.4%; 3: 5.6 and 16.8%; 4: 22.2 and 33.3%; 5: 60.9 and 66.2%).
Figure 3
Figure 3. Box-Whisker-Plot depicting D-MELD scores for the number of positive risk factors in the patient collective.
While there is an increase of median D-MELD-scores with an increasing number of risk factors, this is no significant correlation.
See this image and copyright information in PMC

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