Pretransplant predictors of early mortality in adult recipients of liver transplantation in the MELD-Na Era

Abstract

AimsTo identify pretransplant predictors of early mortality (90 days after transplantation) and evaluate their discriminating capacity in adult liver transplant recipients (LTRs). DesignAn observational, retrospective, nested cases–controls study from a consecutive cohort of LTRs was carried out. SettingUniversity hospital. PatientsAll consecutive LTR between January 2003 and December 2016 were eligible for inclusion. Patients with acute liver failure, previous graft dysfunction, simultaneous multiple organ transplantation, non-heart beating donors, and those needing urgent retransplantation during the study period were excluded. The analysis comprised 471 patients. Main variables of interestPretransplant characteristics were the main variables of interest. The LTR were grouped according to the dependent variable (early mortality). Multivariate logistic regression analysis was conducted to identify predictors of early mortality. The discriminating capacity of the models obtained was evaluated by comparing ROC curves (models versus MELD-Na). ResultsThe MELD-Na score (OR=1.069, 95% CI=1.014–1.127), age >60 years (OR=2.479, 95% CI=1.226–5.015), and LTR height <163cm (OR=4.092, 95% CI=2.115–7.917) were identified as independent predictors of early mortality. The cause of transplantation (hepatocellular carcinoma or decompensated cirrhosis) was identified as a confounding factor. ConclusionsIn LTR due to decompensated cirrhosis, the MELD-Na score, age >60 years, and height <163cm are independent predictors of early mortality. These factors provide a better classification model than the MELD-Na score for early post-transplant mortality.