World Journal of Surgery

, 33:2420 | Cite as

Prediction of Survival After Liver Transplantation for Chronic Severe Hepatitis B Based on Preoperative Prognostic Scores: A Single Center’s Experience in China

  • Liang Xiao
  • Zhi-Ren Fu
  • Guo-Shan Ding
  • Hong Fu
  • Zhi-Jia Ni
  • Zheng-Xin Wang
  • Xiao-Min Shi
  • Wen-Yuan Guo
  • Jun Ma
Article
First Online:

Abstract

Background

The aim of this study was to estimate the utility of a preoperative model of end-stage liver disease (MELD) score and Child-Turcotte-Pugh (CTP) score in predicting the prognosis after othotopic liver transplantation (OLT) for chronic severe hepatitis B (CSHB) and explore the prognostic factors.

Methods

The outcome of 137 patients who underwent OLT using donors after cardiac death (DCDs) for CSHB in our center was reviewed retrospectively. Survival analysis was performed using the Kaplan-Meier method; the log-rank test was used for univariate analysis; and the Cox proportional hazards regression model was used for prognostic factors screening.

Results

The overall mortality rate was 33.6% (46/137); and 1-month, 6-month, 1-year, and 5-year patient survival rates were 75.8, 72.0, 71.0, and 60.1%, respectively. Most patients (33/46) died during the first month after OLT. The area under the curve values generated by the receiver operating characteristics curves were 0.82 [95% confidence interval (CI) 0.72–0.92] and 0.68 (95% CI 0.58–0.79), respectively (P < 0.01), for the MELD and CTP models in predicting 1-month mortality after OLT. Patients with a preoperative MELD score <33.8 or a CTP score <12.5 had significantly better prognosis than those with higher scores (P < 0.05). Other mortality predictors include hepatic encephalopathy, preoperative infection, serum creatinine ≥1.5 mg/dl.

Conclusions

The MELD score was more efficient than the CTP score for evaluating the short-term prognosis in patients with CSHB undergoing OLT using DCDs, which should be taken into consideration during graft allocation.

Keywords

Hepatic Encephalopathy Hepatorenal Syndrome Cold Ischemia Time Hepatic Artery Thrombosis Poor Graft Function 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
This is a preview of subscription content, log in to check access.

Notes

Acknowledgment

We thank Gui-Hua Wang for providing technical support in preparing this paper.

References

  1. 1.
    Marrero J, Martinez FJ, Hyzy R (2003) Advances in critical care hepatology. Am J Respir Crit Care Med 168:1421–1426PubMedCrossRefGoogle Scholar
  2. 2.
    Ostapowicz G, Lee WM (2000) Acute hepatic failure: a Western perspective. J Gastroenterol Hepatol 15:480–488PubMedCrossRefGoogle Scholar
  3. 3.
    Wiesner R, Edwards E, Freeman R et al (2003) Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 124:91–96PubMedCrossRefGoogle Scholar
  4. 4.
    Wang ZX, Yan LN, Wang WT et al (2007) Impact of pretransplant MELD score on posttransplant outcome in orthotopic liver transplantation for patients with acute-on-chronic hepatitis B liver failure. Transplant Proc 39:1501–1504PubMedCrossRefGoogle Scholar
  5. 5.
    Chinese Society of Infectious Diseases and Chinese Society of Hepatology, CMA (2001) Prevention and treatment program for viral hepatitis. Chin J Infect Dis 1:56–62Google Scholar
  6. 6.
    Kamath PS, Wiesner RH, Malinchoc M et al (2001) A model to predict survival in patients with end-stage liver disease. Hepatology 33:464–470PubMedCrossRefGoogle Scholar
  7. 7.
    Pugh RN, Murray-Lyon IM, Dawson JL et al (1973) Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646–649PubMedCrossRefGoogle Scholar
  8. 8.
    Gitlin N (1996) Hepatic encephalopathy. In: Zakim D, Boyer TD (eds) Hepatology: a textbook of liver disease, vol 1, 3rd edn. Saunders, Philadelphia, pp 605–617Google Scholar
  9. 9.
    Hanley JA, McNeil BJ (1982) The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36PubMedGoogle Scholar
  10. 10.
    De Long ER, De Long DM, Clarke-Pearson DL (1988) Comparing the areas under two or more correlated receiver operating characteristics curves: a nonparametric approach. Biometrics 44:837–845CrossRefGoogle Scholar
  11. 11.
    Schisterman EF, Faraggi D, Reiser B et al (2008) Youden Index and the optimal threshold for markers with mass at zero. Stat Med 27:297–315PubMedCrossRefGoogle Scholar
  12. 12.
    World Health Organization. Department of Communicable Diseases Surveillance and Response: Hepatitis B. WHO/CDS/CSR/LYO/2002.2: Hepatitis B. WHO, GenevaGoogle Scholar
  13. 13.
    Polson J, Lee WM, American Association for the Study of Liver Disease (2005) AASLD position paper: the management of acute liver failure. Hepatology 41:1179–1197PubMedCrossRefGoogle Scholar
  14. 14.
    Heidelbaugh JJ, Sherbondy M (2006) Cirrhosis and chronic liver failure. Part II. Complications and treatment. Am Fam Physician 74:767–776PubMedGoogle Scholar
  15. 15.
    Xu JH, Yu YY, Si CW et al (2004) Promoting hepatic growth factor in the treatment of heavy type hepatitis and severe chronic hepatitis: a multicenter clinical study. Hepatobiliary Pancreat Dis Int 3:381–385PubMedGoogle Scholar
  16. 16.
    Patzer JF II, Lopez RC, Zhu Y et al (2002) Bioartificial liver assist devices in support of patients with liver failure. Hepatobiliary Pancreat Dis Int 1:18–25Google Scholar
  17. 17.
    Srikureja W, Kyulo NL, Runyon BA et al (2005) MELD score is a better prognostic model than Child-Turcotte-Pugh score or discriminant function score in patients with alcoholic hepatitis. J Hepatol 42:700–706PubMedCrossRefGoogle Scholar
  18. 18.
    Li Q, Yuan GY, Tang KC et al (2008) Prognostic factors for chronic severe hepatitis and construction of a prognostic model. Hepatobiliary Pancreat Dis Int 7:40–44PubMedGoogle Scholar
  19. 19.
    Yao FY, Saab S, Bass NM et al (2004) Prediction of survival after liver retransplantation for late graft failure based on preoperative prognostic scores. Hepatology 39:230–238PubMedCrossRefGoogle Scholar
  20. 20.
    Forman LM, Lucey MR (2001) Predicting the prognosis of chronic liver disease: an evolution from Child to MELD. Hepatology 33:473–475PubMedCrossRefGoogle Scholar
  21. 21.
    Sumskiene J, Kupcinskas L, Pundzius J et al (2005) Prognostic factors for short and long-term survival in patients selected for liver transplantation. Medicina (Kaunas) 41:39–46Google Scholar
  22. 22.
    Lai N, Guo SH, Zhang DZ et al (2005) A single factor analysis of the prognosis of 301 hepatitis failure cases and a study of a scoring system on their prognostic assessment. Zhonghua Gan Zang Bing Za Zhi 13:586–589PubMedGoogle Scholar
  23. 23.
    Ding HG, Xiang HP, Shan J et al (2005) A scoring model for predicting the prognosis of severe viral hepatitis. Chin Med J (Engl) 118:249–251Google Scholar
  24. 24.
    Farmer DG, Anselmo DM, Ghobrial RM et al (2003) Liver transplantation for fulminant hepatic failure: experience with more than 200 patients over a 17-year period. Ann Surg 237:666–675PubMedCrossRefGoogle Scholar
  25. 25.
    Duran FG, Piqueras B, Romero M et al (1998) Pulmonary complications following orthotopic liver transplant. Transpl Int 11(Suppl 1):S255–S259PubMedCrossRefGoogle Scholar
  26. 26.
    Li XM, Ma L, Yang YB et al (2005) Analyses of prognostic indices of chronic liver failure caused by hepatitis virus. World J Gastroenterol 11:2841–2843PubMedGoogle Scholar
  27. 27.
    Wong T, Devlin J, Rolando N et al (1997) Clinical characteristics affecting the outcome of liver retransplantation of the liver. Transplantation 64:878–882PubMedCrossRefGoogle Scholar
  28. 28.
    Rosen HR, Madden JP, Martin P (1999) A model to predict survival following liver retransplantation. Hepatology 29:365–370PubMedCrossRefGoogle Scholar
  29. 29.
    Doyle HR, Morelli F, McMichael J et al (1996) Hepatic retransplantation: an analysis of risk factors associated with outcome. Transplantation 61:1499–1505PubMedCrossRefGoogle Scholar
  30. 30.
    De Vera ME, Lopez-Solis R, Dvorchik I et al (2009) Liver transplantation using donation after cardiac death donors: long-term follow-up from a single center. Am J Transplant 9:773–781PubMedCrossRefGoogle Scholar
  31. 31.
    Lee KW, Simpkins CE, Montgomery RA et al (2006) Factors affecting graft survival after liver transplantation from donation after cardiac death donors. Transplantation 82:1683–1688PubMedCrossRefGoogle Scholar
  32. 32.
    Zheng S, Feng X, Qing D et al (2008) The tolerance time limits of biliary tracts of liver grafts subjected to warm ischemia and cold preservation: an experimental study in swine. Transplant Proc 40:1629–1634PubMedCrossRefGoogle Scholar
  33. 33.
    Bernat JL, D’Alessandro AM, Port FK et al (2006) Report of a national conference on donation after cardiac death. Am J Transplant 6:281–291PubMedCrossRefGoogle Scholar
  34. 34.
    Chan EY, Olson LC, Kisthard JA et al (2008) Ischemic cholangiopathy following liver transplantation from donation after cardiac death donors. Liver Transpl 14:604–610PubMedCrossRefGoogle Scholar
  35. 35.
    Muiesan P, Girlanda R, Jassem W et al (2005) Single-center experience with liver transplantation from controlled non-heartbeating donors. Ann Surg 242:732–738PubMedCrossRefGoogle Scholar
  36. 36.
    Tojimbara T, Wicomb WN, Garcia-Kennedy R et al (1997) Liver transplantation form non-heart beating donors in rats: influence of viscosity and temperature of initial flushing solutions on graft function. Liver Transpl Surg 3:39–45PubMedGoogle Scholar
  37. 37.
    Pirenne J, Van Gelder F, Coosemans W et al (2001) Type of donor aortic preservation solution and not cold ischemia time is a major determinant of biliary strictures after liver transplantation. Liver Transpl 7:540–545PubMedCrossRefGoogle Scholar
  38. 38.
    Monbaliu D, Crabbé T, Roskams T et al (2005) Livers from non-heart-beating donors tolerate short periods of warm ischemia. Transplantation 79:1226–1230PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2009

Authors and Affiliations

  • Liang Xiao
    • 1
  • Zhi-Ren Fu
    • 1
  • Guo-Shan Ding
    • 1
  • Hong Fu
    • 1
  • Zhi-Jia Ni
    • 1
  • Zheng-Xin Wang
    • 1
  • Xiao-Min Shi
    • 1
  • Wen-Yuan Guo
    • 1
  • Jun Ma
    • 1
  1. 1.Department of Liver TransplantationShanghai Changzheng HospitalShanghaiPeople’s Republic of China

Personalised recommendations