title: Could metabolic liver function tests predict mortality on waiting list for liver transplantation? A study on 560 patients.
abstract: BACKGROUND
  Allocation of graft in liver transplantation (LT) depends mainly on Model for End Stage Liver Disease (MELD) score. We studied the prognostic ability of three metabolic liver function tests in 560 cirrhotic patients listed for transplantation, in comparison with MELD and Child-Turcotte-Pugh (CTP) scores.
  
  
  METHODS
  Indocyanine green retention rate (ICG), aminopyrine breath test (ABT), and galactose elimination capacity were performed at the time of listing in addition to standard biological parameters. Seventy-three patients died on waiting list, 438 were transplanted, and 73 died after LT. Cox regression analysis and receiver operating characteristic curves with c-statistics were calculated after stratification according to CTP and MELD score.
  
  
  RESULTS
  For the mortality before transplantation, c-statistics showed that ICG and ABT had a slightly better prognostic ability (0.73 and 0.68, respectively) than MELD score (0.66), and similar to CTP score (0.70). ABT's prognostic ability remained significant once the MELD score (below and above 20) had already been taken into account. Only ICG had a prognostic ability to predict the survival after LT, even after stratification according to MELD and CTP score.
  
  
  CONCLUSIONS
  Our results strongly support that ABT and ICG may be useful in the ranking of the patients in LT list, adding prognosis information in association with MELD score.
authors.affiliation: Liver Transplantation Unit, Department of Digestive Diseases, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Ecochard
authors.forename: Olivier
authors.initials: O
authors.lastname: Boillot
authors.forename: Olivier
authors.initials: O
authors.lastname: Guillaud
authors.forename: Sabine
authors.initials: S
authors.lastname: Roman
authors.forename: Mustapha
authors.initials: M
authors.lastname: Adham
authors.forename: François
authors.initials: F
authors.lastname: Mion
authors.forename: Jérôme
authors.initials: J
authors.lastname: Dumortier
mesh_terms: D000328:Adult; D000368:Aged; D000632:Aminopyrine / Q000378:metabolism*; D001944:Breath Tests; D004396:Coloring Agents; D058625:End Stage Liver Disease / Q000150:complications / Q000401:mortality* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005690:Galactose / Q000378:metabolism*; D006801:Humans; D007208:Indocyanine Green; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000639:trends*; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011379:Prognosis; D040841:Resource Allocation; D015996:Survival Rate; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D000632:Aminopyrine; D007208:Indocyanine Green; D005690:Galactose