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LT recipient characteristics predict worse outcomes after transplant
In a retrospective cohort study, researchers in Brazil found that liver transplant recipient characteristics have a greater impact on patient outcomes compared with donor characteristics, according to study data.
“The current study confirms that both donor and recipient characteristics must be taken into consideration with respect to post-transplant outcomes and prognostic scores,” the researchers wrote.
Researchers used a hierarchical multiple regression model to evaluate factors related to mortality and graft failure in 2,666 liver transplant patients in São Paulo, Brazil, between January 2006 and August 2012. Of the patients, 1,482 were men and 1,184 were women. Outcome variables, including mortality and graft failure rates, as well as donor clinical, laboratory, intensive care, organ characteristics and recipient clinical data were analyzed.
Overall, the mortality rate among the cohort was 16.2 per 100 person-years (95% CI, 15.1-17.3) and the graft failure rate was 1.8 per 100 person-years (95% CI, 1.5-2.2). These rates indicated that the negative outcome rate was 18 per 100 person-years (95% CI, 16.9-19.2).
A crude analysis showed that age greater than 53 years, male gender, intubation time longer than 5 days, dobutamine use and total bilirubin lower than 0.81 mg/dl to be donor factors associated with a higher negative outcome rate.
In the best risk model, creatinine levels greater than 2.1 mg/dl, total bilirubin greater than 2.11 mg/dl, a serum international normalized ratio greater than 2.7, serum Na+ greater than 141 mg/dl and body surface lower than 1.98 among the recipients, contributed to a higher negative outcome rate, according to the research.
“Our data demonstrated that recipient characteristics have a greater impact on post-transplant outcomes than donor characteristics,” the researchers concluded. “This new concept makes liver transplantation teams rethink about the limits in a MELD allocation system, with many teams competing with each other. The results suggest that although we have some concerns about the donors features, the recipient factors were the heaviest predictors for bad outcomes.” – by Melinda Stevens
Disclosures: The researchers report no relevant financial disclosures.