Purpose:

The objective of that study was to develop a novel prognostic score predicting graft and patient survival after orthotopic liver transplantation (OLT).

Methods:

Prospectively collected data for liver transplants done at our institution between 1990-2011 were reviewed. Cox proportional hazards model was used with the following variables to determine predictors: donor age, sex, BMI, and donor risk index (DRI), recipient age, sex, diagnosis, combined or re-transplants, MELD and Child score, pre-transplant dialysis, intraoperative blood loss, warm and cold ischemia time, blood transfusions in first 24hours post transplant and baseline INR/bilirubin levels and in the first week after transplant.

Results:

716 patients were analyzed. Median DRI was 1.52(1.3-1.8), recipient age 57(50-63) years old, MELD 20(18-27), warm ischemia time 1.1(1-1.3) hours, cold ischemia time 8.7(6.7-11.3) hours and blood loss 1600(900-2700) ml. 34% of patients had HCV. Five-year patient survival was 79% for the entire cohort.

The following variables contributed significantly to the model: cold(>10 hours) and warm(>1.5 hours) ischemia time, blood loss >3000ml, MELD >30, DRI and HCV diagnosis.

The following prognostic score was generated which significantly predicted graft/patient survival (binary variables except for DRI):

Score=cold ischemia time + 2(warm ischemia time) + 1.5(blood loss) + 2(MELD) + HCV – DRI.

Score results divided patients in 3 risk groups: Low: < -1, intermediate: -1 to 0, and high: > 0. High-risk group had a 5-year survival of <50%.

Conclusion: This clinical score predicted patient and graft survival after OLT. If validated, such a tool could potentially be used as an early surrogate marker for interventional studies and to prognosticate transplant patients as early as in the peri-operative course.

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