Predictive index for long-term survival after retransplantation of the… analysis of a 26-year experience in a single center.

- PubMed - NCBI 13/11/15 10:43

PubMed

Abstract Full text links

Ann Surg. 2011 Sep;254(3):444-8; discussion 448-9. doi: 10.1097/SLA.0b013e31822c5878.

Predictive index for long-term survival after retransplantation of the liver in

adult recipients: analysis of a 26-year experience in a single center.
Hong JC1, Kaldas FM, Kositamongkol P, Petrowsky H, Farmer DG, Markovic D, Hiatt JR, Busuttil RW.

Author information

Abstract
OBJECTIVE: To develop a prognostic scoring system for risk stratification of patients with hepatic
graft failure (GF) undergoing retransplants of the liver (ReLT) and improve patient selection.
SUMMARY OF BACKGROUND DATA: Retransplantation of the liver remains controversial
because of inferior outcomes compared with the primary orthotopic liver transplantation (OLT) and
raises concerns of inappropriate utilization of a scarce donor organ resource. Data on risk
stratification of ReLT patients for long-term survival outcomes are limited.
METHODS: We conducted an analysis from our prospective database of 466 adults' ReLT
between February 1984 and September 2010. Mean follow-up was 3 years. Each independent
predictor for allograft failure was assigned risk score (RS) points of 1 or 2, proportional to the
corresponding parameter estimate under the Cox model: Predictive index category (PIC) 1, RS =
0; PIC II, RS = 1 to 2; PIC III, RS = 3 to 4; and PIC IV, RS = 5 to 12.
RESULTS: Eight risk factors predictive for GF after ReLT included recipient age greater than 55
years, Model for End-Stage Liver Disease score greater than 27, history of prior OLT greater than
1, pre-ReLT requirement for mechanical ventilation, serum albumin less than 2.5 g/dL, donor age
greater than 45 years, intraoperative requirement of packed red blood cell transfusion greater than
30 units, and performance of ReLT between 15 and 180 days from the prior OLT. Five-year GF-
free survival was significantly higher in PIC I (65%) than in PIC II (53%), PIC III (43%), and PIC IV
(20%) groups (P < 0.001).
CONCLUSIONS: This risk-stratification model was highly predictive of long-term outcome after
liver retransplantation in adult recipients. This formula provides a practical guide for selection of
candidates for retransplantation of the liver that can lead to improved patient outcomes and
optimal utilization of a scarce resource.

PMID: 21817890 [PubMed - indexed for MEDLINE]

MeSH Terms

http://www.ncbi.nlm.nih.gov/pubmed/21817890 Página 1 de 2
Predictive index for long-term survival after retransplantation of the… analysis of a 26-year experience in a single center. - PubMed - NCBI 13/11/15 10:43

LinkOut - more resources

PubMed Commons PubMed Commons home

0 comments
How to join PubMed Commons

http://www.ncbi.nlm.nih.gov/pubmed/21817890 Página 2 de 2