title: Comparative analysis of outcome following liver transplantation in US veterans.
abstract: The purpose of this study was to evaluate whether there was a difference in mortality following orthotopic liver transplantation (OLT) in a US veteran (VA) population (n = 149) compared to a non-VA (university) population (n = 285) and what factors could explain this difference. Survival following OLT for 149 VA patients was compared with that of 285 university patients. By Kaplan-Meier survival analysis, VA patients had higher mortality than university patients with respective 1-year, 3-year, and 5-year survival of 82%, 75%, and 68% vs. 87%, 82%, and 78% (p = 0.006). Gender, etiology of end-stage liver disease (ESLD) and donor age (i.e. older than 34 years) also significantly influenced survival. However, when donor and recipient age, gender, model for end-stage liver disease (MELD) score, and etiology of liver disease were included with hospital status in a multivariate Cox proportional hazards model, the VA population did not have higher mortality. A final model to predict mortality following transplantation was derived for all 434 patients where individuals were assigned risk scores based on the equation R = 0.219 (gender) + 0.018 (donor age) + 0.032 (recipient age) + 0.021 (MELD), where recipient age, donor age, and MELD score are the respective continuous variables and gender = 1 (men) and 0 for women (c-statistic = 0.71).
authors.affiliation: Department of Medicine, Division of Gastroenterology and Hepatology, Portland Veterans Affairs Medical Center and Oregon Health and Science University, Portland, OR, USA.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Austin
authors.forename: Anna W
authors.initials: AW
authors.lastname: Sasaki
authors.forename: Atif
authors.initials: A
authors.lastname: Zaman
authors.forename: John M
authors.initials: JM
authors.lastname: Rabkin
authors.forename: Ali
authors.initials: A
authors.lastname: Olyaei
authors.forename: Roberta
authors.initials: R
authors.lastname: Ruimy
authors.forename: Susan L
authors.initials: SL
authors.lastname: Orloff
authors.forename: John
authors.initials: J
authors.lastname: Ham
authors.forename: Hugo R
authors.initials: HR
authors.lastname: Rosen
mesh_terms: D000328:Adult; D005260:Female; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000401:mortality; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate; D014481:United States; D014728:Veterans