title: Von Willebrand factor and alkaline phosphatase predict re-transplantation-free survival after the first liver transplantation.
abstract: BACKGROUND
  After liver transplantation (LT), there are liver-related, infectious and cardiovascular complications that contribute to reduced graft survival. These conditions are associated with an increase in the Von Willebrand factor antigen (VWF-Ag), which was previously correlated with survival in cirrhotic patients.
  
  
  OBJECTIVE
  Evaluate VWF-Ag as a predictive marker of re-transplantation-free survival in patients after LT.
  
  
  METHODS
  We measured VWF-Ag in patients after first LT and then followed them prospectively with regard to the primary endpoint, namely re-transplantation-free survival.
  
  
  RESULTS
  There were 6 out of 80 patients who died or received re-LT during follow-up. In these patients, the median VWF-Ag was 510.6%, which was significantly higher (p= 0.001) than in the patients who were alive at the end of follow-up (with a median VWF-Ag = 186.8%). At a cut-off of 286.8%, VWF-Ag was significantly correlated with re-transplantation-free survival (p< 0.001). VWF-Ag was independently associated with re-transplantation-free survival in a multivariate analysis; as was alkaline phosphatase (ALP), but not the model of end-stage liver disease (MELD) score, donor age, nor cold ischemia time. A score combining VWF-Ag and ALP showed an impressive capability in the receiver operating characteristic (ROC) analysis (with area under the curve (AUC) = 0.958) to distinguish between patients with regard to the primary endpoint.
  
  
  CONCLUSIONS
  VWF-Ag is a non-invasive marker that can predict outcome in patients after LT. Its diagnostic performance increased when combined with ALP in a newly developed scoring system.
authors.affiliation: Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Wannhoff
authors.affiliation: Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Conrad
authors.initials: C
authors.lastname: Rauber
authors.affiliation: Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Kilian
authors.initials: K
authors.lastname: Friedrich
authors.affiliation: Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Rupp
authors.affiliation: Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Stremmel
authors.affiliation: Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Karl Heinz
authors.initials: KH
authors.lastname: Weiss
authors.affiliation: Department of General, Visceral and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Schemmer
authors.affiliation: Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Gotthardt
keywords: Alkaline phosphatase; Von Willebrand factor; diagnostic tests; liver transplantation; markers; outcome prediction; scoring system; survival; transplantation