Risk stratification of adult patients undergoing orthotopic liver transplantation for fulminant hepatic failure.
BACKGROUND
Orthotopic liver transplantation (OLT) is an effective treatment for fulminant hepatic failure (FHF), but postOLT mortality is higher for patients with FHF than for patients with other indications for OLT. In the current study, a large cohort of patients who underwent OLT for FHF was evaluated to develop and validate a system useful for estimating postOLT patient survival.


METHODS
The 1,457 patients who underwent OLT for FHF in the United States between 1988 and 2003 were enrolled through the UNOS database. This group was divided into a modeling group (n=972) and a crossvalidation group (n=486). With a multivariate regression analysis, the modeling group was used to identify clinical parameters that had a significant association with postOLT survival. This regression analysis was used to create a scoring system that was subsequently assessed in the crossvalidation group.


RESULTS
Four risk factors were identified with the multivariate analysis: 1) body mass index > or = 30 kg/m2; 2) serum creatinine > 2.0 mg/dL; 3) recipient age > 50 years old; and 4) history of life support. By assigning points based on the number of risk factors present, the scoring system was able to differentiate between low-risk patients (5-year survival, 81%) and high-risk patients (5-year survival, 42%). The relative risk of postOLT mortality increased by approximately 150% for each additional point.


CONCLUSIONS
The scoring system risk-stratified the crossvalidation group and accurately predicted postOLT survival. A scoring system utilizing clinical and demographic information readily available prior to OLT may help predict the probability of survival after OLT for FHF.
Barshes
Neal R
NR
Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
Lee
Timothy C
TC
Balkrishnan
Rajesh
R
Karpen
Saul J
SJ
Carter
Beth A
BA
Goss
John A
JA
D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D016208:Databases, Factual; D005260:Female; D006085:Graft Survival; D006801:Humans; D008020:Life Support Care; D017114:Liver Failure, Acute / Q000401:mortality* / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
D003404:Creatinine