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Vol. 43. Issue 5.
Pages 261-328 (June - July 2019)
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Vol. 43. Issue 5.
Pages 261-328 (June - July 2019)
Original
DOI: 10.1016/j.medine.2019.04.004
Pretransplant predictors of early mortality in adult recipients of liver transplantation in the MELD-Na Era
Predictores pretrasplante de mortalidad precoz en receptores adultos de trasplante hepático en la era MELD-Na
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J.C. Pozo-Laderasa,b,
Corresponding author
drjcpozo@hotmail.com

Corresponding author.
, M. Rodríguez-Perálvarezc,b, M.C. Muñoz-Villanuevad, F. Rivera-Espinara, I. Durban-Garcíaa, J. Muñoz-Trujilloa, J.C. Robles-Aristaa,b, J. Briceño-Delgadoe,b
a UCG Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, Spain
b Instituto Maimónides de Investigación Biomédica IMIBIC, Córdoba, Spain
c UGC Aparato Digestivo, Hospital Universitario Reina Sofía, Córdoba, Spain
d Unidad de Bioestadística Médica, Instituto Maimónides de Investigación Biomédica IMIBIC, Córdoba, Spain
e UGC Cirugía General, Hospital Universitario Reina Sofía, Córdoba, Spain
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Figures (2)
Tables (4)
Table 1. Description of the pretransplantation characteristics of the cohort of liver transplant recipients and cases–controls (N=471).
Table 2. Evaluation of the pretransplantation predictors of early mortality after liver transplant. Bivariate analysis (N=471).
Table 3. Independent pretransplantation predictors of early mortality after liver transplant. Multivariate logistic regression analysis. Final models.
Table 4. Comparison of ROC using the DeLong test.
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Abstract
Aims

To identify pretransplant predictors of early mortality (90 days after transplantation) and evaluate their discriminating capacity in adult liver transplant recipients (LTRs).

Design

An observational, retrospective, nested cases–controls study from a consecutive cohort of LTRs was carried out.

Setting

University hospital.

Patients

All 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 interest

Pretransplant 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).

Results

The 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.

Conclusions

In 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.

Keywords:
Liver transplantation
Early postoperative mortality
Pretransplant risk factors
Resumen
Objetivos

Identificar predictores pretrasplante de mortalidad precoz (90 días postrasplante) y evaluar su capacidad discriminante en receptores adultos de trasplante hepático (RTH).

Diseño

Estudio observacional, retrospectivo, de casos y controles anidados sobre una cohorte consecutiva de RTH.

Ámbito

Hospital Universitario.

Pacientes

Desde enero de 2003 a diciembre de 2016, todos los receptores adultos de trasplante hepático fueron elegibles para inclusión. Fueron excluidos los RTH por fallo hepático agudo, disfunción de un injerto previo, trasplante simultáneo de órganos, de donantes en asistolia, y aquellos que precisaron retrasplante durante el periodo de estudio. Para el análisis se incluyeron 471 pacientes.

Principales variables de interés

Las características pretrasplante fueron las variables de interés. Los RTH fueron agrupados de acuerdo con la variable dependiente (mortalidad precoz). Los predictores se obtuvieron mediante análisis multivariante de regresión logística. La capacidad discriminante de los modelos obtenidos se evaluó mediante comparación de curvas ROC.

Resultados

Se identificaron como predictores independientes de mortalidad precoz: la puntuación MELD-Na (OR=1,069; IC95%=1,014-1,127), la edad mayor de 60 años (OR=2,479; IC95%=1,226-5,015), y la estatura del RTH inferior a 163cm (OR=4,092; IC95%=2,115-7,917), considerándose el motivo del trasplante (carcinoma hepatocelular o cirrosis descompensada) como variable de confusión.

Conclusiones

En los RTH por cirrosis descompensada, la puntuación MELD-Na, la edad mayor de 60 años y la estatura del receptor inferior a 163cm son predictores independientes de mortalidad precoz. Esos predictores producen un modelo que clasifica a los pacientes significativamente mejor que el MELD-Na en relación con la mortalidad precoz.

Palabras clave:
Trasplante hepático
Mortalidad precoz
Factores pretrasplante

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