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Liver Failure/Cirrhosis/Portal Hypertension
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Serum ferritin concentration and transferrin saturation before liver transplantation predict decreased long-term recipient survival†‡
Article first published online: 30 NOV 2011
DOI: 10.1002/hep.24635
Copyright © 2011 American Association for the Study of Liver Diseases
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How to Cite
Weismüller, T. J., Kirchner, G. I., Scherer, M. N., Negm, A. A., Schnitzbauer, A. A., Lehner, F., Klempnauer, J., Schlitt, H. J., Manns, M. P. and Strassburg, C. P. (2011), Serum ferritin concentration and transferrin saturation before liver transplantation predict decreased long-term recipient survival. Hepatology, 54: 2114–2124. doi: 10.1002/hep.24635
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Potential conflict of interest: Dr. Schlitt advises and is on the speakers' bureau of Roche and Novartis. He received grants from Wyeth.
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This study was supported by the German Federal Ministry of Education and Research through the Integrated Research and Treatment Center—Transplantation (reference number: 01EO0802) to Hannover Medical School, Hannover, Germany.
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Publication History
- Issue published online: 30 NOV 2011
- Article first published online: 30 NOV 2011
- Accepted manuscript online: 2 SEP 2011 09:29AM EST
- Manuscript Accepted: 2 AUG 2011
- Manuscript Received: 11 MAR 2011
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Abstract
Serum ferritin (SF) concentration is a widely available parameter used to assess iron homeostasis. It has been described as a marker to identify high-risk patients awaiting liver transplantation (LT) but is also elevated in systemic immune-mediated diseases, metabolic syndrome, and in hemodialysis where it is associated with an inferior prognosis. This study analyzed whether SF is not only a predictor of liver-related mortality prior to LT but also an independent marker of survival following LT. In a dual-center, retrospective study, a cohort of 328 consecutive first-LT patients from Hannover Medical School, Germany (2003-2008, follow-up 1260 days), and 82 consecutive LT patients from Regensburg University Hospital, Germany (2003-2007, follow-up 1355 days) as validation cohort were analyzed. In patients exhibiting SF ≥365 μg/L versus <365 μg/L prior to LT, 1-, 3-, and 5-year post-LT survival was 73.3% versus 81.1%, 64.4% versus 77.3%, and 61.1% versus 74.4%, respectively (overall survival P = 0.0097), which was confirmed in the validation cohort (overall survival of 55% versus 83.3%, P = 0.005). Multivariate analyses identified SF ≥365 μg/L combined with transferrin saturation (TFS) <55%, hepatocellular carcinoma, and the survival after LT (SALT) score as independent risk factors for death. In patients with SF concentrations ≥365 μg/L and TFS <55%, overall survival was 54% versus 74.8% in the remaining group (P = 0.003). In the validation cohort, it was 28.6% versus 72% (P = 0.017), respectively. Conclusion: SF concentration ≥365 μg/L in combination with TFS <55% before LT is an independent risk factor for mortality following LT. Lower TFS combined with elevated SF concentrations indicate that acute phase mechanisms beyond iron overload may play a prognostic role. SF concentration therefore not only predicts pre-LT mortality but also death following LT. (HEPATOLOGY 2011;)