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Correlation between physiological assessment and outcome after liver transplantation
S W Chung1, A W Kirkpatrick, H L Kim
1Departments of Surgery and Medicine, University of British Columbia, and the British Columbia Transplant Society, Vancouver, British Columbia, Canada.
American Journal of Surgery
|August 10, 2000
Summary
Predicting liver transplant outcomes using detailed physiological scores (SAPS, APACHE II, APACHE III) did not improve accuracy over current patient status. Standard listing status remains a comparable predictor for post-transplant survival and function.
Area of Science:
- Hepatology
- Transplant Surgery
- Medical Informatics
Background:
- Organ donor shortages necessitate optimal utilization of liver grafts.
- Pre-transplant recipient assessment is crucial for predicting post-transplant outcomes.
Purpose of the Study:
- To evaluate the utility of physiological scoring systems in predicting liver transplant outcomes.
- To compare the predictive accuracy of SAPS, APACHE II, and APACHE III scores against current patient listing status.
Main Methods:
- Retrospective analysis of 31 liver transplant recipients with a minimum 5-year follow-up.
- Examination of pretransplant variables including activation status, SAPS, APACHE II, and APACHE III scores.
- Correlation of scores with posttransplant mortality and functional recovery.
Main Results:
- No significant difference in 5-year mortality between status 1 and status 2+ patients (14.3% vs. 30%, P=NS).
- Physiological scoring systems (SAPS, APACHE II/III) showed no significant correlation with posttransplant mortality or functional outcomes.
- 18 of 22 (81.8%) surviving patients returned to their pretransplant activity levels.
Conclusions:
- Detailed physiological scoring systems do not offer superior accuracy in predicting liver transplant outcomes compared to existing listing status parameters.
- Current pretransplant listing status effectively stratifies patients for predicting post-transplant results.