Introduction

Currently liver allocation -in contrast to allocation of other organs- is based on urgency in many countries and survival benefit is not included. Aim of this study was to analyze the value of hospitalization prior transplantation (Tx) and pre-operative life support as predictors for transplant outcome.

Materials and Methods

All patients who underwent liver Tx from 2005 to 2016 at the Charité – Berlin, Germany, were analyzed for hospitalization and life support defined as dialysis, mechanical ventilation and need of catecholamines.

Results and Discussion

From 1244 patients, 264 underwent Tx coming from an intensive care unit (ICU), 178 patients from a regular ward and 802 from home. Of all recipients 187 required dialysis, 123 ventilation and 101 catecholamines.

Patients coming from the ICU were significantly younger but sicker according to their higher labMELD at day of Tx. Not surprisingly these patients had a significantly lower 3-month, 1-year and 3-year survival compared to patients coming from home (ICU vs. home; 76,9% vs. 94,4% and 65,9% vs. 87,5% and 64,4% vs. 82,4%; all p=0,000).

Interestingly no significant difference was shown between patients from the ICU and the regular ward, not even for short term survival (3 month: p=0,057; 1 year: p=0,132; 3 year: p=0,556).

Subgroup analysis revealed that the length of ICU stay prior to Tx had a significant impact on patient survival if longer than 6 days (1-6 days vs. 7-14 days; 1 year p=0,036). Remarkably no changes between 7-14 days or >14 days could be noticed (p=0,469).

Dialysis prior to Tx was associated with an inferior outcome compared to patients without renal replacement therapy (3-year survival: 56,1% vs. 79,7% p=0,000). These results remained significant even for patients receiving only dialysis and no other life support therapy whereas ventilation or catecholamines alone did not influence survival. There were no significant differences between the pre-operative labMELD of these three groups. However, recipients with ventilation and catecholamines showed similar results as patient with dialysis only (3 year: p=0,890).

Conclusion

Hospitalization status as well as life support before Tx are valuable predictors for patient survival following liver Tx and should be considered for the allocation process.

CITATION INFORMATION: Wiering L., Ritschl P., Hippler-Benscheidt M., Aigner F., Biebl M., Eurich D., Schmelzle M., Sauer I., Kotsch K., Pratschke J., Öllinger R. Hospitalization and Life Support before Liver Transplantation – Easily Available Predictors for Post-Transplant Patient Survival Am J Transplant. 2017;17 (suppl 3).

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