title: Predictive factors for early mortality following liver transplantation.
abstract: OBJECTIVE
  To retrospectively review our liver transplant performance to identify factors that influenced early outcomes and to prospectively test their validity in predicting outcomes.
  
  
  METHODS
  Clinical records from 190 patients with liver transplants (LT; n = 200) performed between 1991 and 1997 were reviewed and the data evaluated by univariate and multivariate analyses regarding clinical outcome. The prognostic model thus obtained was prospectively evaluated in 55 patients undergoing transplant between 1999 and 2000.
  
  
  RESULTS
  Main indication for transplant was post-necrotic cirrhosis (61%), mostly HCV(+). The majority of patients were Child-Pugh C status (46%). Post-operative mortality at 3 months was 15.3%. Risk factors predicting death were: Child-Pugh C status (OR 1.3), pre-LT renal insufficiency (OR 5.8), malnutrition (OR 2.9) and technically complex surgery requiring cross-clamping with or without bypass (OR 4.9). None of the donor factors was significant. Prospectively applied to predict outcome in the 55 patients, the model had a sensitivity of 80% and a specificity of 88.8% with a higher-than-anticipated accuracy with a positive predictive value of 61.5% and a negative predictive value of 95.3%.
  
  
  CONCLUSIONS
  Pre-LT renal insufficiency is the most significant risk factor for early mortality and suggests that LT should be performed before evidence of irreversible renal insufficiency becomes manifest.
authors.affiliation: Liver Transplant Unit of the Department of Surgery, Hospital Vall D'Hebron, Barcelona, Spain. bilbao@hg.vhebron.es
authors.forename: Itxarone
authors.initials: I
authors.lastname: Bilbao
authors.forename: Luis
authors.initials: L
authors.lastname: Armadans
authors.forename: Jose L
authors.initials: JL
authors.lastname: Lazaro
authors.forename: Ernest
authors.initials: E
authors.lastname: Hidalgo
authors.forename: Luis
authors.initials: L
authors.lastname: Castells
authors.forename: Carlos
authors.initials: C
authors.lastname: Margarit
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome