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Reuters Health Information (2006-01-19): Age of donor and recipient, size of transplant center up risk in liver transplants


Age of donor and recipient, size of transplant center up risk in liver transplants

Last Updated: 2006-01-19 18:30:23 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Cause of liver failure, age of donor and recipient, donor-recipient ABO groups, and transplant center size are among the predictors of 3- and 12-month mortality in liver transplant recipients, according to a study that used data compiled in the European Liver Transplant Registry (ELTR).

Although other models identifying factors associated with outcomes have been published, the authors of the study note, most are based on data from single centers assessing survival at 12 months after transplantation.

Dr. Andrew K. Burroughs, from the Royal Free Hampstead NHS Trust in London, and associates analyzed outcomes for transplants performed in 23 European countries between 1988 and 2003. For 3-month outcomes, they included 31,094 individuals; 12-month outcomes were based on 27,165 transplants.

According to their report in the January 21st issue of The Lancet, 12% of subjects had died by 3 months post-transplantation and 18% by 12 months. Compared with those treated between 2000 and 2003, those treated earlier were at a higher risk of death (p < 0.0001).

The leading cause of death was infection (27% at 3 months), followed by nonliver organ failure (11%). Intraoperative death accounted for 7%, technical complications for 8%, primary liver dysfunction for 6%, cardiovascular causes for 8% and cerebrovascular causes for 7%. No more than 3% of deaths were caused by liver complications or rejection, nontumoral recurrence, gastrointestinal causes, or tumors.

Multivariable logistic regression modeling showed that acute liver failure was associated with increased risk, whereas hepatocellular carcinoma, alcoholic cirrhosis, hepatitis C cirrhosis and primary biliary cirrhosis were associated with better outcomes.

Donor age older than 60 years, non-identical donor-recipient blood groups, increasing recipient age, lower United Network of Organ Sharing (UNOS) status, receipt of a split or reduced graft, and total ischemia time longer than 13 hours were related to increased mortality.

Better survival was associated with donor age younger than 40 years, hepatitis B virus surface antigen positivity, and being treated at centers that perform at least 70 transplants per year.

In their report, Dr. Burroughs' group has published mathematical models that they say can be used to assess an individual's risk of mortality under different transplant conditions, "giving clinicians important data on which to base strategic decisions about transplant policy in particular individuals or groups."

Lancet 2006;367:225-232.

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