Pragmatic Surgical Risk Assessment Criteria in Critically Ill Patients Prior to Liver Transplantation

C. Bonham, Z. Tulu, M. Melcher, P. Kwo, W. Concepcion, A. Ahmed, C. Esquivel.

Liver Transplant Program, Stanford University School of Medicine, Stanford, CA.

Meeting: 2018 American Transplant Congress

Abstract number: C233

Keywords: Liver transplantation, Outcome, Risk factors

Session Information

Session Name: Poster Session C: Liver: Recipient Selection

Session Type: Poster Session

Date: Monday, June 4, 2018

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Hall 4EF

Futility rules in critically ill patients awaiting liver transplantation (LT) are lacking in this era of severe organ shortage of organs. We aim to identify the predictors of poor post-LT outcomes in critically ill patients awaiting LT.

Methods:

A retrospective analysis of 132 consecutive adult LTs between August 2015 and October 2017 was performed. Patients were divided in two groups: a true MELD of < 35 and those 35 or greater. The methodology was based on organ system failure as follows: 1) Pulmonary (mechanical ventilation); 2) Hematology (platelet count of < 30K); 3) CNS (Glasgow Coma Score [GCS] of 9 or less); 4) Renal (dialysis); 5) Immune (WBC < 1K or > 25K); and 6) CV (> 2 vasopressor-dependency). For this analysis a correlation between each risk factor and survival outcomes was examined individually. A risk score based on the sum of risk factors for each patient was developed, and the correlation between risk score and survival outcomes was studied. A 2-sample t-test was used for statistical analysis.

Results:

Analysis of both groups (<35 and 35+ MELD scores) risk score and survival outcomes are shown in Table1:

MELD Category	N of risk factors (risk scoring)	N of patients	1 year survival
<35	0-2	89	94.4%
35+	0-2	30	93.3%
35+	3-5	13	46%

MELD Category N of risk factors (risk scoring) N of patients 1 year survival

<35 0-2 89 94.4%

35+ 0-2 30 93.3%

35+ 3-5 13 46%

While patients with 0-2 risk factors had a 1-year survival of 94%, patients with 3 or more risk factors had a 1-year survival of 46%.

Results of the univariate analysis are shown in Table 2:

Factor	N	1 Year Survival	p- value
MELD 35+	43 (vs. 89)	79% vs 94%	0.03
Mechanical Ventilation	13 (vs. 119)	61% vs 92%	0.051
On>2 Vasopressors	14 (vs. 118)	57% vs 93%	0.022
On Dialysis	30 (vs. 102)	67% vs 96%	0.03
WBC (<1 or >25)	2 (vs. 130)	0% vs 91%	n/a
Platelet (30 or less)	10 (vs. 122)	80% vs 90%	0.5
GCS 9 or less	4 (vs. 128)	25% vs 91%	0.07
Risk Factors 3-5	13 (vs. 119)	46% vs 94%	0.00

Factor N 1 Year Survival p- value

MELD 35+ 43 (vs. 89) 79% vs 94% 0.03

Mechanical Ventilation 13 (vs. 119) 61% vs 92% 0.051

On>2 Vasopressors 14 (vs. 118) 57% vs 93% 0.022

On Dialysis 30 (vs. 102) 67% vs 96% 0.03

WBC (<1 or >25) 2 (vs. 130) 0% vs 91% n/a

Platelet (30 or less) 10 (vs. 122) 80% vs 90% 0.5

GCS 9 or less 4 (vs. 128) 25% vs 91% 0.07

Risk Factors 3-5 13 (vs. 119) 46% vs 94% 0.00

In the multivariate analysis, the need for dialysis was the only significant factor. Age and donor quality did not influence the outcomes.

Conclusions:

This simple guideline is a reliable tool to identify those patients at a high risk for a fatal outcome prior to transplantation.

CITATION INFORMATION: Bonham C., Tulu Z., Melcher M., Kwo P., Concepcion W., Ahmed A., Esquivel C. Pragmatic Surgical Risk Assessment Criteria in Critically Ill Patients Prior to Liver Transplantation Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Bonham C, Tulu Z, Melcher M, Kwo P, Concepcion W, Ahmed A, Esquivel C. Pragmatic Surgical Risk Assessment Criteria in Critically Ill Patients Prior to Liver Transplantation [abstract]. https://atcmeetingabstracts.com/abstract/pragmatic-surgical-risk-assessment-criteria-in-critically-ill-patients-prior-to-liver-transplantation/. Accessed December 3, 2024.

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