Langenbeck's Archives of Surgery

, Volume 400, Issue 7, pp 805–811 | Cite as

Association of serum zinc levels with liver function and survival in patients awaiting liver transplantation

  • Kilian Friedrich
  • Carina Baumann
  • Maik Brune
  • Andreas Wannhoff
  • Christian Rupp
  • Sabine G. Scholl
  • Christoph Antoni
  • Matthias Dollinger
  • Christoph Neumann-Haefelin
  • Karl Heinz Weiss
  • Wolfgang Stremmel
  • Peter Schemmer
  • Daniel Nils Gotthardt
Original Article



Zinc is an important trace element with catalytic and defensive functions. We assessed the impact of zinc deficiency in patients with end-stage liver disease awaiting liver transplantation.


Serum zinc levels were measured at the time of evaluation for liver transplantation (n = 368). Patients were dichotomized in two groups based on low and normal zinc serum levels.


Serum zinc levels are tightly associated with liver function as patients with low zinc levels (n = 226) had a higher Model for End-Stage Liver Disease (MELD) score (15.0 [5.0–40.0]) than patients with normal zinc (n = 142) levels (9.0 [6.0–34.0]; p < 0.00). Multivariate analysis demonstrated that serum zinc levels function as an independent predictor of hepatic decompensation (hydropic decompensation: odds ratio [OR] 0.82; 95 % confidence interval [CI] 0.70–0.96; p = 0.015; hepatic encephalopathy: OR 0.80; 95 % CI 0.71–0.90; p = 0.000; spontaneous bacterial peritonitis: OR 0.85; 95 % CI 0.72–1.00; p = 0.047; hepatorenal syndrome: OR 0.83; 95 % CI 0.72–0.95; p = 0.011). Actuarial survival free of liver transplantation was reduced for low-zinc patients (26.7 ± 4.0 months; 95 % CI 18.8–34.6) compared to patients with normal zinc levels (30.9 ± 3.0 months; 95 % CI 24.9–36.9; p = 0.008). Reduction of zinc levels for patients on the transplantation list resulted in a 28.3-fold increased risk of death/liver transplantation (95 % CI 3.2–244.8, p < 0.001).


Serum zinc levels are associated with reduced survival in end-stage liver disease patients. Whether or not zinc supplementation might be beneficial for patients on a liver transplantation list requires further study.


Serum zinc levels Liver transplantation End-stage liver disease Actuarial survival free of liver transplantation 



DNG was funded by a grant of the Deutsche Forschungsgemeinschaft.

Conflicts of interest


Authors’ contributions

Study concept and design: KF, WS, DNG

Acquisition of data: KF, CB, AW, CA, CR, CNH, MD

Analysis and interpretation of data: KF, DNG, KHW, PS, PS

Critical revision of the manuscript: PS, PS, KHW, CA, CNH, MD, SGS

Statistical analysis: KF, DNG

Technical or material support: KF, CB, DNG

Supplementary material

423_2015_1334_MOESM1_ESM.docx (18 kb)
ESM 1 (docx 17 kb)
423_2015_1334_MOESM2_ESM.docx (14 kb)
ESM 2 (docx 14 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Kilian Friedrich
    • 1
  • Carina Baumann
    • 1
  • Maik Brune
    • 2
  • Andreas Wannhoff
    • 1
  • Christian Rupp
    • 1
  • Sabine G. Scholl
    • 3
  • Christoph Antoni
    • 4
  • Matthias Dollinger
    • 5
  • Christoph Neumann-Haefelin
    • 6
  • Karl Heinz Weiss
    • 1
  • Wolfgang Stremmel
    • 1
  • Peter Schemmer
    • 7
  • Daniel Nils Gotthardt
    • 1
  1. 1.Department of Internal Medicine IVUniversity Hospital of HeidelbergHeidelbergGermany
  2. 2.Department of Internal Medicine IUniversity Hospital of HeidelbergHeidelbergGermany
  3. 3.Department of Social PsychologyUniversity of MannheimMannheimGermany
  4. 4.Department of Medicine II (Gastroenterology, Hepatology and Infectious Diseases)University Hospital of Heidelberg at MannheimMannheimGermany
  5. 5.Department of Internal Medicine IUniversity of UlmUlmGermany
  6. 6.Department of Medicine IIFreiburg University Medical Center, University of FreiburgFreiburgGermany
  7. 7.Department of SurgeryUniversity Hospital of HeidelbergHeidelbergGermany

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