title: 3-month and 12-month mortality after first liver transplant in adults in Europe: predictive models for outcome.
abstract: BACKGROUND
  Mortality after liver transplantation depends on heterogeneous recipient and donor factors. Our aim was to assess risk of death and to develop models to help predict mortality after liver transplantation.
  
  
  METHODS
  We analysed data from 34,664 first adult liver transplants from the European Liver Transplant Registry to identify factors associated with mortality at 3-months (n=21,605 in training dataset) and 12-months (n=18,852 in training dataset) after transplantation. We used multivariable logistic regression models to generate mortality scores for each individual, and assessed model discrimination and calibration on an independent validation dataset (n=9489 for 3-month model and n=8313 for 12-month model).
  
  
  RESULTS
  2540 of 21,605 (12%) individuals in the 3-month training sample had died by 3 months. Compared with those transplanted in 2000-03, those transplanted earlier had a higher risk of death. Increased mortality at 3-months post-transplantation was associated with acute liver failure (adjusted odds ratio 1.61), donor age older than 60 years (1.16), compatible (1.22) or incompatible (2.07) donor-recipient blood group, older recipient age (1.12 per 5 years), split or reduced graft (1.96), total ischaemia time of longer than 13 h (1.38), and low United Network for Organ Sharing score (score 1: 2.43; score 2: 1.67). However, cirrhosis with hepatocellular carcinoma, alcohol cirrhosis, hepatitis C or primary biliary cirrhosis, donor age 40 years or younger, or less, hepatitis B, and larger size of transplant centre (> or = 70 transplants per year) were associated with improved early outcomes. The 3-month mortality score discriminated well between those who did and did not die in the validation sample (C statistic=0.688). We noted similar findings for 12-month mortality, although deaths were generally underestimated at this timepoint.
  
  
  CONCLUSIONS
  The 3-month and 12-month mortality models can be effectively used to assess outcomes both within and between centres. Furthermore, the models provide a means of assessing the risk of post-transplantation mortality, giving clinicians important data on which to base strategic decisions about transplant policy in particular individuals or groups.
authors.affiliation: Liver Transplantation and Hepatobiliary Medicine, Royal Free Hampstead NHS Trust, London NW3 2QG, UK.
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Burroughs
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Sabin
authors.forename: Keith
authors.initials: K
authors.lastname: Rolles
authors.forename: Valerie
authors.initials: V
authors.lastname: Delvart
authors.forename: Vincent
authors.initials: V
authors.lastname: Karam
authors.forename: John
authors.initials: J
authors.lastname: Buckels
authors.forename: John G
authors.initials: JG
authors.lastname: O'Grady
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: Jurgen
authors.initials: J
authors.lastname: Klempnauer
authors.forename: Neville
authors.initials: N
authors.lastname: Jamieson
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
authors.forename: Jan
authors.initials: J
authors.lastname: Lerut
authors.forename: Jean
authors.initials: J
authors.lastname: de Ville de Goyet
authors.forename: Stephen
authors.initials: S
authors.lastname: Pollard
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
authors.forename: Xavier
authors.initials: X
authors.lastname: Rogiers
authors.forename: Ferdinand
authors.initials: F
authors.lastname: Muhlbacher
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Garcia Valdecasas
authors.forename: Christopher
authors.initials: C
authors.lastname: Broelsch
authors.forename: Daniel
authors.initials: D
authors.lastname: Jaeck
authors.forename: Joaquin
authors.initials: J
authors.lastname: Berenguer
authors.forename: Enrique Moreno
authors.initials: EM
authors.lastname: Gonzalez
authors.forename: Rene
authors.initials: R
authors.lastname: Adam
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D005060:Europe; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012042:Registries; D013997:Time Factors