Thursday, August 1, 2013

A Validated Model for Predicting Outcome after Liver Transplantation: Implications on Transplanting the Extremely Sick

Given the organ shortage, there is a need to optimize outcome after liver transplantation (LT). We defined post-transplant hospital length of stay > 60 days (LOS>60) as a surrogate of suboptimal outcome. In the first phase of the study, a “Study cohort” (SC) of 643 patients was used to identify risk factors and construct a mathematical model to identify recipients with anticipated inferior results. In the second phase, a cohort of 417 patients was used for validation of the model (“Validation Cohort”- VC). In the SC, 65 patients (10.1%) had LOS > 60 days. One- and three-year patient/graft survival rates were 81.9%/76.1% and 73.4%/67.4%, respectively. Patient and graft survival of those with LOS >60 days were inferior (p < 0.0001) while transplant cost was greater (3.42 RU vs. 1 RU, p < 0.0001). In a multivariable analysis, pre-transplant dialysis (p< 0.001), mechanical ventilation (p< 0.015), MELD (p<0.003) and age (p<0.009) were predictors of LOS > 60 days {ROC curve - 0.75 (95% CI [0.70, 0.81]}. In the VC, 53 patients (12.7%) were expected to have adverse outcome by the model. These patients had longer LOS (p < 0.0001), higher cost (< 0.0001) and inferior patient and graft survival (p< 0.007) (read more) Print this post

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