Highlights
- •We identified 5 recipient factors in HCV negative transplant recipients associated with significant morbidity and mortality.
- •Graft survival within 5 years based on points (any combination) was 77.2% (0–4), 69.1% (5–8) and 57.9% (>8).
- •In recipients with >8 points, graft survival was 42% (MELD <25) and 50% (MELD 25–35) if donors had donor risk index ≥1.7.
- •Recipients with ≥5 points: longer hospitalization, more rehab admissions, higher incidence of cardiac disease and CKD.
Background and Aims
Over the last decade, liver transplantation of sicker, older non-hepatitis C cirrhotics
with multiple co-morbidities has increased in the United States. We sought to identify
an easily applicable set of recipient factors among HCV negative adult transplant
recipients associated with significant morbidity and mortality within five years after
liver transplantation.
Methods
We collected national (n = 31,829, 2002–2015) and center-specific data. Coefficients
of relevant recipient factors were converted to weighted points and scaled from 0–5.
Recipient factors associated with graft failure included: ventilator support (five
patients; hazard ratio [HR] 1.59; 95% CI 1.48–1.72); recipient age >60 years (three
patients; HR 1.29; 95% CI 1.23–1.36); hemodialysis (three patients; HR 1.26; 95% CI
1.16–1.37); diabetes (two patients; HR 1.20; 95% CI 1.14–1.27); or serum creatinine
≥1.5 mg/dl without hemodialysis (two patients; HR 1.15; 95% CI 1.09–1.22).
Results
Graft survival within five years based on points (any combination) was 77.2% (0–4),
69.1% (5–8) and 57.9% (>8). In recipients with >8 points, graft survival was 42% (model
for end-stage liver disease [MELD] score <25) and 50% (MELD score 25–35) in recipients
receiving grafts from donors with a donor risk index >1.7. In center-specific data
within the first year, subjects with ≥5 points (vs. 0–4) had longer hospitalization (11 vs. 8 days, p <0.01), higher admissions for rehabilitation (12.3% vs. 2.7%, p <0.01), and higher incidence of cardiac disease (14.2% vs. 5.3%, p <0.01) and stage 3 chronic kidney disease (78.6% vs. 39.5%, p = 0.03) within five years.
Conclusion
The impact of co-morbidities in an MELD-based organ allocation system need to be reassessed.
The proposed clinical tool may be helpful for center-specific assessment of risk of
graft failure in non-HCV patients and for discussion regarding relevant morbidity
in selected subsets.
Lay summary
Over the last decade, liver transplantation of sicker, older patient with multiple
co-morbidities has increased. In this study, we show that a set of recipient factors
(recipient age >60 years, ventilator status, diabetes, hemodialysis and creatinine
>1.5 mg/dl) can help identify patients that may not do well after transplant. Transplanting
sicker organs in patients with certain combinations of these characteristics leads
to lower survival.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: February 15, 2018
Accepted:
February 8,
2018
Received in revised form:
February 1,
2018
Received:
June 7,
2017
Identification
Copyright
© 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
