Predicting Survival After Liver Transplant

A new model based on specific characteristics of the donor and the recipient may help predict survival after liver transplantation, according to a new study.

George Ioannou, M.D., M.S., of the Veterans Affairs (VA) Puget Sound Health Care System (Seattle, WA, USA) sought to identify donor and recipient characteristics that are important predictors of graft survival following liver transplantation. Using information provided by the U.S. united network for organ sharing (UNOS; Richmond, VA, USA), he identified all patients who had a liver transplant between 1994 and 2003. He did not include patients who had donors under age 10 or over age 75, living donors, split-liver donors, non-heart-beating donors, or donors with serum sodium concentration greater than 170 mmoles/l. He also excluded patients with multiple organ transplants, previous liver transplants, and incomplete information.

For the 20,301 patients who remained, including 6,477 with hepatitis C (HCV), Dr. Ioannou used statistical models to examine the relationship between donor and recipient characteristics and survival after transplant. He then created two models that predict survival after liver transplant--one for patients without HCV and one for those with HCV. He validated the models using data from patients not included in their derivation.

The study found that the donor age, cold ischemia time, recipient model end-stage liver disease (MELD) score, and cause of liver disease have the greatest impact on survival. However, the best model for patients without HCV included donor age, cold ischemia time, gender, race/ethnicity, recipient age, body mass index (BMI), MELD score, status at time of transplantation, diabetes mellitus, cause of liver disease, and serum albumin. For patients with HCV, the best model included the same donor characteristics, and all recipient characteristics except cause of liver disease and serum albumin. The findings were published in the November 2006 issue of Liver Transplantation.

"Risk scores and predicted survivals determined from such models may be an objective way to assess the risk of a given liver donor, recipient, or donor/recipient combination,” said Dr. Ioannou. "This model could be used to inform liver transplant candidates and their doctors what post-transplant survival would be expected when a given donor is offered and may be particularly helpful in marginal or high risk donors.”



Related Links:
Puget Sound Health Care System
United Network for Organ Sharing