Burroughs et al developed models for predicting mortality 3 and 12 months after a first liver transplant in a European adult. This can help identify patients who may benefit from closer monitoring and more aggressive management. The authors are from multiple transplant centers from across Europe.
Patient selection: adult with first liver transplant
Parameters:
(1) year of transplant
(2) reason for liver transplant
(3) age of donor
(4) donor and recipient ABO type
(5) HBsAg status
(6) recipient's age
(7) graft type
(8) UNOS status
(9) total ischemia time in hours
(10) number of transplants done at center
Point Assignment for 3 Month Mortality
|
Parameter |
Finding |
Points |
|---|---|---|
|
year of transplant |
1988 - 1991 |
0.62 |
|
|
1992 - 1995 |
0.22 |
|
|
1996 - 1999 |
0.08 |
|
|
2000 - 2003 |
0 |
|
reason for liver transplant |
acute liver failure |
0.48 |
|
|
hepatocellular carcinoma |
-0.29 |
|
|
alcoholic cirrhosis |
-0.26 |
|
|
HCV cirrhosis |
-0.20 |
|
|
primary biliary cirrhosis |
-0.52 |
|
|
other |
0 |
|
age of the donor |
<= 40 years of age |
-0.21 |
|
|
41 - 60 years |
0 |
|
|
> 60 years of age |
0.15 |
|
donor and recipient ABO |
identical |
0 |
|
|
compatible |
0.20 |
|
|
incompatible |
0.73 |
|
HBSAg |
negative |
0 |
|
|
positive |
-0.38 |
|
recipient's age in years |
|
0.11 * (((age) - 40) / 5) |
|
type of transplant |
split or reduced graft |
0.67 |
|
|
whole liver |
0 |
|
UNOS status |
1 |
0.89 |
|
|
2 |
0.51 |
|
|
3 |
0 |
|
|
4 |
-0.43 |
|
total ischemia time for transplanted organ |
<= 13 hours |
0 |
|
|
> 13 hours |
0.32 |
|
|
unknown |
0.67 |
|
number of transplants done |
<= 36 per year |
0.30 |
|
|
37 - 69 per year |
0 |
|
|
>= 70 per year |
-0.23 |
where:
• The reference age for a recipient was 40 years of age. A recipient less than that will have a parameter estimate that is negative.
• A transplant performed after 2003 may be a problem for scoring. Since the mortality covers the first 3-12 months after the transplant the estimates for earlier transplants will not be an ongoing issue. For the implementation I will assign 0 (reference value) for a transplant done after 2003.
Point Assignment for 12 Month Mortality
|
Parameter |
Finding |
Points |
|---|---|---|
|
year of transplant |
1988 - 1991 |
0.61 |
|
|
1992 - 1995 |
0.23 |
|
|
1996 - 1999 |
0 |
|
|
2000 - 2003 |
0 |
|
reason for liver transplant |
acute liver failure |
0.27 |
|
|
hepatocellular carcinoma |
0.09 |
|
|
alcoholic cirrhosis |
-0.33 |
|
|
HCV cirrhosis |
-0.09 |
|
|
primary biliary cirrhosis |
-0.57 |
|
|
other |
0 |
|
age of the donor |
<= 40 years of age |
-0.27 |
|
|
41 - 60 years |
0 |
|
|
> 60 years of age |
0.19 |
|
donor and recipient ABO |
identical |
0 |
|
|
compatible |
0.14 |
|
|
incompatible |
0.91 |
|
HBSAg |
negative |
0 |
|
|
positive |
-0.28 |
|
recipient's age in years |
|
0.13 * (((age) - 40) / 5) |
|
type of transplant |
split or reduced graft |
0.45 |
|
|
whole liver |
0 |
|
UNOS status |
1 |
0.85 |
|
|
2 |
0.43 |
|
|
3 |
0 |
|
|
4 |
-0.35 |
|
total ischemia time for transplanted organ |
<= 13 hours |
0 |
|
|
> 13 hours |
0.24 |
|
|
unknown |
0.52 |
|
number of transplants done |
<= 36 per year |
0.19 |
|
|
37 - 69 per year |
0 |
|
|
>= 70 per year |
-0.21 |
X for 3 month mortality =
= SUM(points for all 10 parameters) - 3.38
Y for 12 month mortality =
= SUM(points for all 10 parameters) - 2.94
probability of 3 month mortality =
= 1 / (1 + EXP((-1) * X))
probability of 12 month mortality =
= 1 / (1 + EXP((-1) * Y))
Specialty: Gastroenterology, Surgery, general
