Correlation between physiological assessment and outcome after liver transplantation.
BACKGROUND
Critical shortages of organ donors for transplantation require appropriate utilization of this scarce resource. The purpose of this study was to assess whether use of physiological parameters of preliver transplant recipients is helpful in determining eventual outcome.


METHODS
Between October 1989 and June 1999, 215 liver transplants were performed on 199 patients at the Vancouver Hospital nad Health Sciences Centre. Thirty-one patients undergoing transplantation between May 1993 and June 1994 were retrospectively evaluated to obtain a minimum 5-year follow-up. Variables examined included pretransplant activation status (status 1, at home; status 2, hospitalized; status 3, admitted to intensive care; status 4, mechanical ventilation), simplified acute physiological score (SAPS), Acute Physiology, Age, and Chronic Health Evaluation (APACHE) II, and APACHE III scores at the time of transplantation. The scores were correlated to posttransplant mortality and functional outcome.


RESULTS
The 5-year mortality for status 1 patients was 14.3% versus 30% for patients listed as status 2 or greater (P = not significant). There were no significant differences in any of the physiological scoring assessments with regard to posttransplant mortality or functional assessment. Of the surviving patients, 18 of 22 who were employed, in school, or active at home pretransplant returned to their pretransplant activity.


CONCLUSIONS
Detailed physiological scoring systems are no more accurate in predicting outcome after liver transplant than current listing status parameters.
Departments of Surgery and Medicine, University of British Columbia, and the British Columbia Transplant Society, Vancouver, British Columbia, Canada.
S W
SW
Chung
A W
AW
Kirkpatrick
H L
HL
Kim
C H
CH
Scudamore
E M
EM
Yoshida
D018806:APACHE; D000203:Activities of Daily Living; D000704:Analysis of Variance; D015897:Comorbidity; D000075202:Contraindications; D003422:Critical Care / Q000706:statistics & numerical data; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality* / Q000502:physiology*; D016015:Logistic Models; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome