Abstract
Background/Aims: Liver transplantation remains the only definitive treatment for patients with end-stage
primary biliary cirrhosis, although the optimal timing of the procedure remains uncertain.
The aim of the study was to use prognostic modelling to determine the optimal timing
of transplantation for patients with primary biliary cirrhosis.
Methods: A prognostic model for predicting the survival of patients after transplantation
was generated using the Cox regression model with data from 312 patients transplanted
for primary biliary cirrhosis at the Queen Elizabeth Hospital, Birmingham. The prognosis
after transplantation was compared to that without transplantation (using a previously
published prognostic index for non-transplantation) both in these patients and in
98 non-transplanted primary biliary cirrhosis patients dying from the liver disease,
in order to establish at what stage the prognosis with transplantation was better
than without transplantation.
Results: The prognostic index for transplantation included the following significant prognostic
variables: serum bilirubin, serum albumin, age, year of transplantation, and the presence
of ascites or treatment with diuretics. Comparison of prognosis with and without transplantation
showed that the predicted gain in survival after transplantation becomes increasingly
positive when the 6-month survival probability in the absence of transplantation falls
below 0.85. In the non-transplanted patients this occurs on average about 8 months
before death.
Conclusions: Comparison of the prognosis with and without transplantation provides a rational
method for determining the optimum timing of the procedure which occurs approximately
when the predicted 6-month survival probability without transplantation falls below
0.85.
Keywords
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Article info
Publication history
Accepted:
September 11,
1998
Received in revised form:
August 7,
1998
Received:
March 30,
1998
Identification
Copyright
© 1999 Published by Elsevier Inc.
