title: The association of pretransplant ferritin level with waiting list and post-transplant survival. Does ferritin actually predict outcome?
abstract: Recent data suggest an association of serum ferritin (SF) with waiting list (WL) and postliver transplant (LT) outcomes. To assess the predictive capacity of SF on pre- and post-LT outcomes, and to identify whether recipient or donor liver siderosis is associated with post-LT survival; a retrospective analysis of 1079 patients assessed for first LT, 2000-2007 was performed. Iron deposition in the liver tissue was assessed using a semi-quantitative grading system. Median age was 54 (18-82) years and 67% were male. Seventeen per cent had hepatocellular carcinoma (HCC). Median Model for End-stage Liver Disease MELD score was 14 (6-40), ferritin was 174 μg/l (4-4597) with 36.5% had a SF ≥ μg/l. Age (OR = 1.028) and MELD score (OR = 1.158) were independently associated with WL mortality (P < 0.001), whilst SF was not (P = NS). Age (OR = 1.018), HCC (OR = 1.542) and cold ischemia time (CIT) ≥ 10 h (OR = 1.418) were independently associated with post-LT survival (P < 0.05). Explant siderosis grade <2 was seen in 376 (71.7%) patients. Patients with explant siderosis grade ≥ 2 had inferior 12-month post-LT survival (P = 0.030). Presence of graft siderosis (15.8% of patients) was not associated with survival. In conclusion, we found a limited role for SF as a prognostic indicator for pre- or post-transplant survival.
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: Mohammad A B
authors.initials: MA
authors.lastname: Al-Freah
authors.forename: Stephen
authors.initials: S
authors.lastname: Kriese
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Foxton
authors.forename: Alberto
authors.initials: A
authors.lastname: Quaglia
authors.forename: Adrian
authors.initials: A
authors.lastname: Bomford
authors.forename: Nigel D
authors.initials: ND
authors.lastname: Heaton
authors.forename: John G
authors.initials: JG
authors.lastname: O'Grady
authors.forename: Kosh
authors.initials: K
authors.lastname: Agarwal
authors.forename: Julia A
authors.initials: JA
authors.lastname: Wendon
authors.forename: Michael A
authors.initials: MA
authors.lastname: Heneghan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D058625:End Stage Liver Disease / Q000097:blood / Q000401:mortality; D005260:Female; D005293:Ferritins / Q000097:blood*; D006801:Humans; D008107:Liver Diseases / Q000473:pathology; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012806:Siderosis / Q000473:pathology; D014850:Waiting Lists / Q000401:mortality
chemical_list: D005293:Ferritins
keywords: hepatic; iron; mortality; transplantation