Matching donors and recipients.
This study identifies the major risk factors associated with outcome after liver transplantation, showing that candidates for this surgery can be stratified into differential risk categories at the time of the actual surgery. All the livers used were flushed with University of Wisconsin solution. The study is a retrospective multivariate analysis of 2376 consecutive transplantations performed on 2019 recipients between November 1, 1987, and December 31, 1993. Donor variables studied were age, sex, blood type, cause of death, intensive care unit length of stay, body mass index, use of pressors (dopamine infusion > 10 micrograms/kg/min or continuous infusion of epinephrine or norepinephrine), use of pitressin, cardiopulmonary resuscitation, terminal transaminase levels, serum sodium level at procurement, and total ischemia time. Recipient variables studied were age; sex; blood type; indication for liver transplantation; history of liver transplantation or upper abdominal surgery; United Network for Organ Sharing urgency status; need for mechanical ventilation; primary immunosuppression; and preoperative bilirubin level, prothrombin time, and creatinine level. The variables independently associated with outcome were donor age, female donor sex, ischemia time, recipient age, prior liver transplant, preoperative mechanical ventilation, preoperative bilirubin level, preoperative creatine level, indication for transplantation and primary immunosuppression used. The results of this study not only give us insight into the probable outcomes of individual patients, but also show that this stratification can be useful when comparing results across different groups or in helping to choose the best donor-recipient combination based on the calculated probability of a favorable outcome.
Marino
I R
IR
Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, PA 15213, USA.
Doria
C
C
Doyle
H R
HR
Gayowski
T J
TJ
D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D016001:Confidence Intervals; D005260:Female; D006085:Graft Survival; D006648:Histocompatibility / Q000276:immunology; D006650:Histocompatibility Testing / Q000379:methods*; D006801:Humans; D016031:Liver Transplantation / Q000276:immunology / Q000379:methods* / Q000401:mortality; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012737:Sex Factors; D015996:Survival Rate; D014019:Tissue Donors; D014184:Transplantation, Homologous