Bilirubin appears to be the only independent variable affecting mortality on liver transplant waiting list if waiting time exceeds 1 year.
BACKGROUND
The Model for End-Stage Liver Disease (MELD) score has been shown to be the best predictor of short-term mortality on the liver transplant waiting list in the United States but waiting time often exceeds 1 year in many countries. We wanted to identify the factors affecting mortality on the liver transplant waiting list in Singapore where waiting time for liver transplant exceeds 1 year.


METHODS
All patients who were listed on the liver transplant waiting list in Singapore from January 1997 to December 2003 excluding those who were transplanted were analyzed. MELD was calculated according to the United Network for Organ Sharing formula. Univariate analysis was performed to identify factors affecting mortality on the waiting list and multivariate analysis by logistic regression. Categorical and continuous variables were compared with the chi-square and Mann-Whitney U tests.


RESULTS
There were 48 patients in the study. We found that on univariate analysis, bilirubin, INR, MELD score, and Child's score significantly influenced mortality on the waiting list but on multivariate analysis, bilirubin was the only independent prognostic indicator of mortality on the waiting list (LR = 1.97; 95% confidence interval = 1.08 to 3.61). INR was found to be significantly correlated to bilirubin with Pearson correlation (R = 0.63, P < .001).


CONCLUSIONS
Bilirubin is the only independent factor affecting mortality on the liver transplant waiting list where waiting time exceeds 1 year.
Lee
Y-M
YM
Department of Medicine, National University of Singapore, Singapore. mdcleeym@nus.edu.sg
Wai
C-T
CT
Da Costa
M
M
Lee
K-H
KH
Sutedja
D
D
Tan
K-C
KC
Isaac
J
J
Lim
S-G
SG
D000704:Analysis of Variance; D001663:Bilirubin / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D005260:Female; D006509:Hepatitis B / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014850:Waiting Lists
D015415:Biomarkers; D001663:Bilirubin