J Korean Soc Transplant.  2014 Dec;28(4):211-218. 10.4285/jkstn.2014.28.4.211.

The Analysis of Prognostic Factors Affecting Survival in Liver Transplantation: A Single Institution Experience

Affiliations
  • 1Department of Surgery, Gachon University Gil Medical Center, Gachon Graduate School of Medicine, Incheon, Korea. kimkk@gilhospital.com

Abstract

BACKGROUND
Liver transplantation is considered as the most powerful modality for patients with acute on chronic liver failure and fulminant hepatic failure. The aim of this study is to identify potential prognostic factors that may affect survival after emergent liver transplantation.
METHODS
A total of 42 patients who underwent emergent liver transplantation at Gachon University Gil Medical Center from June 2005 to May 2013 were enrolled. The clinical scoring system analyzed for this study were as follows: Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), Model for end-stage liver disease with incorporation of serum sodium (MELD-Na), Acute physiology and chronic health evaluation II (APACHE II), and Sequential Organ Failure Assessment (SOFA).
RESULTS
Preoperative SOFA and APACHE scores were closely related with patient's survival after the operation. Also, the changed value of SOFA while patients waited for their transplantation showed to be significant. In a univariate analysis, serum bilirubin and Glasgow Coma Scale (GCS) showed statistical significance for patient's prognosis. Several factors, such as the use of mechanical ventilator and inotropic agent for treating multiple organ failure were also important. The central nervous system and cardiovascular scores showed an intimate relation with the survival group by a more detailed analysis in SOFA. In a multivariate analysis, SOFA and bilirubin levels affected patient's survival.
CONCLUSIONS
In emergent liver transplantation with acute on chronic liver failure and fulminant liver failure, recipient's hepatic function is an important factor along with the donated liver condition l eading to successful operation. Also, it is important to pay attention to the progression of organ failure in predicting the prognosis.

Keyword

Liver transplantation; Prognostic factor; Organ failure

MeSH Terms

APACHE
Bilirubin
Central Nervous System
End Stage Liver Disease
Glasgow Coma Scale
Humans
Liver
Liver Diseases
Liver Failure, Acute
Liver Transplantation*
Multiple Organ Failure
Multivariate Analysis
Prognosis
Sodium
Ventilators, Mechanical
Bilirubin
Sodium

Figure

  • Fig. 1. Receiver operating characteristic (ROC) curves for pre-operative Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), model for end-stage liver disease with incorporation of serum sodium (MELD-Na), Sequential Organ Failure Assessment (SOFA), and Acute Physiology And Chronic Health Evaluation II (APACHE) II scoring system. Each value marked at Table 6.


Reference

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