title: Prediction of postoperative mortality in liver transplantation in the era of MELD-based liver allocation: a multivariate analysis.
abstract: OBJECTIVE
  Liver transplantation is the only curative treatment for end-stage liver disease. While waiting list mortality can be predicted by the MELD-score, reliable scoring systems for the postoperative period do not exist. This study's objective was to identify risk factors that contribute to postoperative mortality.
  
  
  METHODS
  Between December 2006 and March 2011, 429 patients underwent liver transplantation in our department. Risk factors for postoperative mortality in 266 consecutive liver transplantations were identified using univariate and multivariate analyses. Patients who were <18 years, HU-listings, and split-, living related, combined or re-transplantations were excluded from the analysis. The correlation between number of risk factors and mortality was analyzed.
  
  
  RESULTS
  A labMELD ≥20, female sex, coronary heart disease, donor risk index >1.5 and donor Na+>145 mmol/L were identified to be independent predictive factors for postoperative mortality. With increasing number of these risk-factors, postoperative 90-day and 1-year mortality increased (0-1: 0 and 0%; 2: 2.9 and 17.4%; 3: 5.6 and 16.8%; 4: 22.2 and 33.3%; 5-6: 60.9 and 66.2%).
  
  
  CONCLUSIONS
  In this analysis, a simple score was derived that adequately identified patients at risk after liver transplantation. Opening a discussion on the inclusion of these parameters in the process of organ allocation may be a worthwhile venture.
authors.affiliation: Department of General and Transplant Surgery, Ruprecht-Karls University, Heidelberg, Germany.
authors.forename: Helge
authors.initials: H
authors.lastname: Bruns
authors.affiliation: Department of General and Transplant Surgery, Ruprecht-Karls University, Heidelberg, Germany.
authors.forename: Vladimir J
authors.initials: VJ
authors.lastname: Lozanovski
authors.affiliation: Department of General and Transplant Surgery, Ruprecht-Karls University, Heidelberg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Schultze
authors.affiliation: Department of General and Transplant Surgery, Ruprecht-Karls University, Heidelberg, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Hillebrand
authors.affiliation: Department of General and Transplant Surgery, Ruprecht-Karls University, Heidelberg, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Hinz
authors.affiliation: Department of General and Transplant Surgery, Ruprecht-Karls University, Heidelberg, Germany.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.affiliation: Department of General and Transplant Surgery, Ruprecht-Karls University, Heidelberg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Schemmer
mesh_terms: D056808:Biostatistics / Q000379:methods*; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects* / Q000191:economics; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D040841:Resource Allocation / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis