Mortality and Its Determinants in Adult Patients with End-stage Liver Disease on Waiting List for Liver Transplantation: A Preliminary Report on Baseline Data

Abstract

Background: Prevention of death in patients on the waiting list for liver transplantation (LT) is a major concern to prioritize organ allocation. Since the model for the end-stage liver disease (MELD) and its modifications have many shortages, there is a need for further refinement of the allocation strategy. Objectives: The current study aimed at assessing the predictors of mortality in LT candidates in a more comprehensive manner with the possible implications to improve the care of such patients and assist in developing better strategies for organ allocation. Methods: In the current cohort study, 544 adult LT candidates with end-stage liver disease were followed up for a mean of 12 months in three-month intervals. Data analysis was performed in Nutritionist, SPSS, and R software, using Kaplan-Meier, Cox proportional hazard (HRC), and LASSO Cox regression hazard (HRL) tests. Results: The mean age of the patients was 46.7 ± 13.7 years; the majority were male (n = 336, 61.7%). At the end of the study, 414 (76.1%) subjects were still alive and 130 (23.9%) dead. The cumulative percentages of death were 33.1%, 57.7%, and 79.2% after 3, 6, and 12 months of waiting for a donor, respectively. Although there was a strong association between having hepatopulmonary syndrome (HPS) (HRC = 4.7, HRL = 1.8), a history of myocardial infarction (MI) (HRC = 3.3, HRL = 1.6), low-carbohydrate (CHO) diet (HRC = 2.7, HRL = 1.5), and mortality, it was weak for MELD score. Moreover, a serum level of CA 125, high polymorphonuclear (PMN) count, weight loss, a high level of alanine aminotransferase (ALT), positive hepatitis B virus (HBV) markers, high mean corpuscular volume (MCV) of red blood cells, ascites, and edema of gallbladder wall had association with mortality in LT patients. Conclusions: In addition to MELD score, HPS, a history of MI, low CHO intake, weight loss, ascites, PMN, CA 125, ALT, hepatitis B surface antigen, MCV, blood urea nitrogen, and gallbladder wall thickness are predictors of mortality in LT candidates and need to be considered in the LT allocation system.