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Serum ferritin concentration and transferrin saturation before liver transplantation predict decreased long-term recipient survival

Authors

  • Tobias J. Weismüller,

    1. Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
    2. Integrated Research and Treatment Center—Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
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  • Gabriele I. Kirchner,

    1. Department of Internal Medicine I, Regensburg University Hospital, Regensburg, Germany
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  • Marcus N. Scherer,

    1. Department of Surgery, Regensburg University Hospital, Regensburg, Germany
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  • Ahmed A. Negm,

    1. Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
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  • Andreas A. Schnitzbauer,

    1. Department of Surgery, Regensburg University Hospital, Regensburg, Germany
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  • Frank Lehner,

    1. Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
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  • Jürgen Klempnauer,

    1. Department of General, Visceral and Transplant Surgery, Hannover Medical School, Hannover, Germany
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  • Hans J. Schlitt,

    1. Department of Surgery, Regensburg University Hospital, Regensburg, Germany
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  • Michael P. Manns,

    1. Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
    2. Integrated Research and Treatment Center—Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
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  • Christian P. Strassburg

    Corresponding author
    1. Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
    2. Integrated Research and Treatment Center—Transplantation (IFB-Tx), Hannover Medical School, Hannover, Germany
    • Professor of Gastroenterology and Hepatology, Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl Neuberg Straße 1, 30655 Hannover, Germany
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    • fax: +49 511 532 4896


  • Potential conflict of interest: Dr. Schlitt advises and is on the speakers' bureau of Roche and Novartis. He received grants from Wyeth.

  • 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.

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;)

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