title: Preoperative factors associated with outcome and their impact on resource use in 1148 consecutive primary liver transplants.
abstract: BACKGROUND
  Hepatic transplantation is a highly effective but costly treatment for end-stage hepatic dysfunction. One approach to improve efficiency in the use of scarce organs for transplantation is to identify preoperative factors that are associated with poor outcome posttransplantation. This may assist both in selecting patients optimal for transplantation and in identifying strategies to improve survival.
  
  
  METHODS
  In the present work, we retrospectively reviewed consecutive liver transplants performed at the University of California at Los Angeles during a 6-year period and determined preoperative variables that were associated with outcome in primary grafts. In addition, we used the hospital's cost accounting database to determine the impact of these variables on the degree of resource use by high-risk patients.
  
  
  RESULTS
  We found five variables to have independent prognostic value in predicting graft survival after primary liver transplantation: (1) donor age, (2) recipient age, (3) donor sodium, (4) recipient creatinine, and (5) recipient ventilator requirement pretransplant. Recipient ventilator requirement and elevated creatinine were associated with significant increases in resource use during the transplant admission.
  
  
  CONCLUSIONS
  Patients at high risk for graft failure and costly transplants can be identified preoperatively by a set of parameters that are readily available, noninvasive, and inexpensive. Selection of recipients on the basis of these data would improve the efficiency of liver transplantation and reduce its cost.
authors.affiliation: Harrison Department of Surgical Research, Hospital of the University of Pennsylvania, Philadelphia, USA.
authors.forename: J F
authors.initials: JF
authors.lastname: Markmann
authors.forename: J W
authors.initials: JW
authors.lastname: Markmann
authors.forename: D A
authors.initials: DA
authors.lastname: Markmann
authors.forename: A
authors.initials: A
authors.lastname: Bacquerizo
authors.forename: J
authors.initials: J
authors.lastname: Singer
authors.forename: C D
authors.initials: CD
authors.lastname: Holt
authors.forename: J
authors.initials: J
authors.lastname: Gornbein
authors.forename: H
authors.initials: H
authors.lastname: Yersiz
authors.forename: M
authors.initials: M
authors.lastname: Morrissey
authors.forename: S M
authors.initials: SM
authors.lastname: Lerner
authors.forename: S V
authors.initials: SV
authors.lastname: McDiarmid
authors.forename: R W
authors.initials: RW
authors.lastname: Busuttil
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D017048:Health Care Costs; D015276:Health Care Rationing; D006801:Humans; D016031:Liver Transplantation / Q000191:economics; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome