Prognostic factors for survival of patients on the liver transplant waiting list

Abstract

Aim. A single-center prospective cohort study was conducted to identify the factors determining the survival of patients with end-stage liver disease (ESLD) who were on the waiting list for liver transplantation. Material and Methods. A total of 112 patients were examined including 28 individuals who died within six months of followup. The mean score of the model for end-stage liver disease (MELD) was 26.4 ± 3.72 (16–36) among the deceased. Results. Compared to survivors, the deceased patients with end-stage liver diseases had higher incidences of complex heart rhythm disorders. These conditions include runs of supraventricular and ventricular tachycardia, episodes of ventricular trigeminy, a higher number of supraventricular extrasystoles, and the changes in QTc interval duration and QTc interval dispersion. The study showed that compared to the liver transplant recipients that survived, the casualties showed some common characteristics such as lower values of tricuspid valve annular plane systolic excursion; increased values of right heart size, inferior vena cava diameter, peak tricuspid regurgitation velocity, and systolic pressure in the pulmonary artery; decreased ratio of transtricuspid flow velocity in the early diastole to flow velocity in the right atrial systole phase; and higher values of troponin I [0.60 (0.14–1.00) ng/mL vs. 0.24 (0.095–0.465) ng/mL, p = 0.024] and NTproBNP [125.0 (74.0–187.5) pg/mL vs. 82.0 (25.0–125.0) pg/mL, p = 0.011]. Conclusions. Heart rate, troponin I level, and NTproBNP value were identified as additional factors determining the risk of adverse outcomes in liver failure patients on the waiting list for liver transplantation. The study resulted in the development of an informative and efficient mathematical model allowing for assessment of sudden death risk in liver failure patients on the waiting list for liver transplantation.