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Prediction of Postoperative Mortality in Liver Transplantation in the Era of MELD-Based Liver Allocation: A Multivariate Analysis

BACKGROUND AND AIMS: Liver transplantation is the only curative treatment for end-stage liver disease. While waiting list mortality can be predicted by the MELD-score, reliable scoring systems for the postoperative period do not exist. This study's objective was to identify risk factors that co...

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Autores principales: Bruns, Helge, Lozanovski, Vladimir J., Schultze, Daniel, Hillebrand, Norbert, Hinz, Ulf, Büchler, Markus W., Schemmer, Peter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4048202/
https://www.ncbi.nlm.nih.gov/pubmed/24905210
http://dx.doi.org/10.1371/journal.pone.0098782
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author Bruns, Helge
Lozanovski, Vladimir J.
Schultze, Daniel
Hillebrand, Norbert
Hinz, Ulf
Büchler, Markus W.
Schemmer, Peter
author_facet Bruns, Helge
Lozanovski, Vladimir J.
Schultze, Daniel
Hillebrand, Norbert
Hinz, Ulf
Büchler, Markus W.
Schemmer, Peter
author_sort Bruns, Helge
collection PubMed
description BACKGROUND AND AIMS: Liver transplantation is the only curative treatment for end-stage liver disease. While waiting list mortality can be predicted by the MELD-score, reliable scoring systems for the postoperative period do not exist. This study's objective was to identify risk factors that contribute to postoperative mortality. METHODS: Between December 2006 and March 2011, 429 patients underwent liver transplantation in our department. Risk factors for postoperative mortality in 266 consecutive liver transplantations were identified using univariate and multivariate analyses. Patients who were <18 years, HU-listings, and split-, living related, combined or re-transplantations were excluded from the analysis. The correlation between number of risk factors and mortality was analyzed. RESULTS: A labMELD ≥20, female sex, coronary heart disease, donor risk index >1.5 and donor Na(+)>145 mmol/L were identified to be independent predictive factors for postoperative mortality. With increasing number of these risk-factors, postoperative 90-day and 1-year mortality increased (0–1: 0 and 0%; 2: 2.9 and 17.4%; 3: 5.6 and 16.8%; 4: 22.2 and 33.3%; 5–6: 60.9 and 66.2%). CONCLUSIONS: In this analysis, a simple score was derived that adequately identified patients at risk after liver transplantation. Opening a discussion on the inclusion of these parameters in the process of organ allocation may be a worthwhile venture.
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spelling pubmed-40482022014-06-09 Prediction of Postoperative Mortality in Liver Transplantation in the Era of MELD-Based Liver Allocation: A Multivariate Analysis Bruns, Helge Lozanovski, Vladimir J. Schultze, Daniel Hillebrand, Norbert Hinz, Ulf Büchler, Markus W. Schemmer, Peter PLoS One Research Article BACKGROUND AND AIMS: Liver transplantation is the only curative treatment for end-stage liver disease. While waiting list mortality can be predicted by the MELD-score, reliable scoring systems for the postoperative period do not exist. This study's objective was to identify risk factors that contribute to postoperative mortality. METHODS: Between December 2006 and March 2011, 429 patients underwent liver transplantation in our department. Risk factors for postoperative mortality in 266 consecutive liver transplantations were identified using univariate and multivariate analyses. Patients who were <18 years, HU-listings, and split-, living related, combined or re-transplantations were excluded from the analysis. The correlation between number of risk factors and mortality was analyzed. RESULTS: A labMELD ≥20, female sex, coronary heart disease, donor risk index >1.5 and donor Na(+)>145 mmol/L were identified to be independent predictive factors for postoperative mortality. With increasing number of these risk-factors, postoperative 90-day and 1-year mortality increased (0–1: 0 and 0%; 2: 2.9 and 17.4%; 3: 5.6 and 16.8%; 4: 22.2 and 33.3%; 5–6: 60.9 and 66.2%). CONCLUSIONS: In this analysis, a simple score was derived that adequately identified patients at risk after liver transplantation. Opening a discussion on the inclusion of these parameters in the process of organ allocation may be a worthwhile venture. Public Library of Science 2014-06-06 /pmc/articles/PMC4048202/ /pubmed/24905210 http://dx.doi.org/10.1371/journal.pone.0098782 Text en © 2014 Bruns et al http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.
spellingShingle Research Article
Bruns, Helge
Lozanovski, Vladimir J.
Schultze, Daniel
Hillebrand, Norbert
Hinz, Ulf
Büchler, Markus W.
Schemmer, Peter
Prediction of Postoperative Mortality in Liver Transplantation in the Era of MELD-Based Liver Allocation: A Multivariate Analysis
title Prediction of Postoperative Mortality in Liver Transplantation in the Era of MELD-Based Liver Allocation: A Multivariate Analysis
title_full Prediction of Postoperative Mortality in Liver Transplantation in the Era of MELD-Based Liver Allocation: A Multivariate Analysis
title_fullStr Prediction of Postoperative Mortality in Liver Transplantation in the Era of MELD-Based Liver Allocation: A Multivariate Analysis
title_full_unstemmed Prediction of Postoperative Mortality in Liver Transplantation in the Era of MELD-Based Liver Allocation: A Multivariate Analysis
title_short Prediction of Postoperative Mortality in Liver Transplantation in the Era of MELD-Based Liver Allocation: A Multivariate Analysis
title_sort prediction of postoperative mortality in liver transplantation in the era of meld-based liver allocation: a multivariate analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4048202/
https://www.ncbi.nlm.nih.gov/pubmed/24905210
http://dx.doi.org/10.1371/journal.pone.0098782
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