Comparative Analysis of Outcome Following Liver Transplantation in US Veterans

Authors

  • Gregory L. Austin,

    1. Department of Medicine, Division of Gastroenterology and Hepatology, Portland Veterans Affairs Medical Center and Oregon Health and Science University
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  • Anna W. Sasaki,

    1. Department of Medicine, Division of Gastroenterology and Hepatology, Portland Veterans Affairs Medical Center and Oregon Health and Science University
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  • Atif Zaman,

    1. Department of Medicine, Division of Gastroenterology and Hepatology, Portland Veterans Affairs Medical Center and Oregon Health and Science University
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  • John M. Rabkin,

    1. Department of Surgery, Liver Transplantation Program, Portland Veterans Affairs Medical Center and Oregon Health and Science University, Portland, OR, USA
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  • Ali Olyaei,

    1. Department of Medicine, Division of Gastroenterology and Hepatology, Portland Veterans Affairs Medical Center and Oregon Health and Science University
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  • Roberta Ruimy,

    1. Department of Medicine, Division of Gastroenterology and Hepatology, Portland Veterans Affairs Medical Center and Oregon Health and Science University
    2. Department of Surgery, Liver Transplantation Program, Portland Veterans Affairs Medical Center and Oregon Health and Science University, Portland, OR, USA
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  • Susan L. Orloff,

    1. Department of Surgery, Liver Transplantation Program, Portland Veterans Affairs Medical Center and Oregon Health and Science University, Portland, OR, USA
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  • John Ham,

    1. Department of Surgery, Liver Transplantation Program, Portland Veterans Affairs Medical Center and Oregon Health and Science University, Portland, OR, USA
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  • Hugo R. Rosen

    Corresponding author
    1. Department of Medicine, Division of Gastroenterology and Hepatology, Portland Veterans Affairs Medical Center and Oregon Health and Science University
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*Corresponding author: Hugo R. Rosen, rosenhu@ohsu.edu

Abstract

The purpose of this study was to evaluate whether there was a difference in mortality following orthotopic liver transplantation (OLT) in a US veteran (VA) population (n = 149) compared to a non-VA (university) population (n = 285) and what factors could explain this difference. Survival following OLT for 149 VA patients was compared with that of 285 university patients. By Kaplan-Meier survival analysis, VA patients had higher mortality than university patients with respective 1-year, 3-year, and 5-year survival of 82%, 75%, and 68% vs. 87%, 82%, and 78% (p = 0.006). Gender, etiology of end-stage liver disease (ESLD) and donor age (i.e. older than 34 years) also significantly influenced survival. However, when donor and recipient age, gender, model for end-stage liver disease (MELD) score, and etiology of liver disease were included with hospital status in a multivariate Cox proportional hazards model, the VA population did not have higher mortality. A final model to predict mortality following transplantation was derived for all 434 patients where individuals were assigned risk scores based on the equation R = 0.219 (gender) + 0.018 (donor age) + 0.032 (recipient age) + 0.021 (MELD), where recipient age, donor age, and MELD score are the respective continuous variables and gender = 1 (men) and 0 for women (c-statistic = 0.71).

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