Predicting early allograft failure and mortality after liver transplantation: The role of the postoperative model for end-stage liver disease score

Authors


  • This work was funded by intramural grant support from the Department of Anesthesiology of Columbia University College of Physicians and Surgeons (New York, NY).

Address reprint requests to Gebhard Wagener, M.D., Department of Anesthesiology, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, P&S Box 46 (PH-5), New York, NY 10032-3784. Telephone: 212-305-6494; FAX: 212-305-2182; E-mail: gw72@columbia.edu

Abstract

Early allograft dysfunction (EAD) is a serious complication after liver transplantation (LT). There is no uniform definition of EAD, and most definitions are based on arbitrary laboratory values. The aim of this study was to devise a definition of EAD that maximizes the predictive power for early death and graft failure. In this single-center, retrospective study, the ability of the international normalized ratio (INR), total bilirubin, aspartate aminotransferase (AST), physiological Model for End-Stage Liver Disease (MELD) score, and serum albumin levels within 7 days after LT to predict 90-day mortality or graft loss was compared with 2 previously used definitions of EAD: (1) peak total bilirubin level >10 mg/dL on days 2 to 7 and (2) either a total bilirubin level >10 mg/dL or an INR >1.6 on day 7 or an AST or alanine aminotransferase level >2000 IU/L within the first 7 days. Of 572 enrolled LT patients 38 died or required retransplantation within 90 days. Peak INR, total bilirubin level, AST levels, and MELD scores were predictors of 90-day graft failure. MELD score on postoperative day 5 was the best predictor with an area under the curve of the receiver operating characteristic curve of 0.812 (95% CI: 0.739-0.886, P < 0.001). The best cutoff of MELD score on day 5 for predicting 90-day mortality or graft loss was 18.9. A MELD score >18.9 on postoperative day 5 was a better predictor than any other laboratory value or definition of EAD. This study has demonstrated that the MELD score can be a useful tool not only for pretransplant graft allocation but also for postoperative risk stratification. Liver Transpl 19:534–542, 2013. © 2013 AASLD.

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