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Predictors of one-year pretransplant survival in patients with cirrhosis
M Oellerich1, M Burdelski, H U Lautz
1Institut für Klinische Chemie, Medizinische Hochschule Hannover, Germany.
Insights
Dynamic liver function tests, including indocyanine green half-life and monoethylglycinexylidide formation, combined with the Pugh score, can predict survival in advanced cirrhosis patients awaiting liver transplantation.
Area of Science:
- Hepatology
- Transplant Surgery
- Medical Diagnostics
Background:
- Advanced cirrhosis significantly impacts patient survival and necessitates accurate prognostic tools for liver transplantation.
- Conventional liver function tests and clinical scores have limitations in predicting pretransplant survival.
Purpose of the Study:
- To evaluate the predictive value of dynamic liver function tests and conventional markers for pretransplant survival in patients with advanced cirrhosis.
- To identify optimal combinations of tests for improving transplant candidate selection and timing.
Main Methods:
- Prospective study of 101 patients with histologically confirmed cirrhosis.
- Assessment of indocyanine green half-life, monoethylglycinexylidide formation, bilirubin, albumin, and Pugh score.
- Stepwise survival analysis using the Cox proportional-hazards model.
Main Results:
- Pugh score, monoethylglycinexylidide formation, and indocyanine green half-life were independent predictors of 1-year survival.
- Parallel combination of Pugh score and monoethylglycinexylidide test showed highest prognostic sensitivity (82%).
- Series combination of Pugh score/indocyanine green or monoethylglycinexylidide/indocyanine green tests yielded highest specificity (96-97%).
Conclusions:
- Dynamic liver function tests, particularly indocyanine green half-life and monoethylglycinexylidide formation, significantly improve survival prediction in advanced cirrhosis.
- Combining these dynamic tests with the Pugh score enhances prognostic accuracy for liver transplant candidate selection and timing.
Abstract:
The aim of this prospective study was to examine the usefulness of flow-dependent dynamic liver function tests and conventional methods of evaluating liver function as predictors of pretransplant survival in patients with advanced cirrhosis. Patients who underwent orthotopic liver transplantation within the follow-up period of 365 days were excluded. One hundred one patients with histologically confirmed cirrhosis were studied. Fifty-eight patients had post-hepatitic cirrhosis, 13 had cryptogenic cirrhosis and 30 had biliary cirrhosis. During follow-up, 28 patients died of their liver diseases. At entry, we recorded indocyanine green half-life, monoethylglycinexylidide formation from lidocaine, bilirubin and albumin serum concentrations, activities of cholinesterase and alkaline phosphatase, prothrombin time, clinical complications of ascites and encephalopathy and the Pugh score. These variables were subjected as covariates to a stepwise survival analysis by use of the Cox proportional-hazards model. At the final step, Pugh score, monoethylglycinexylidide formation and indocyanine green half-life were found to be the only independent variables significantly related to 1-yr survival. The parallel combination of Pugh score and monoethylglycinexylidide test yielded the highest prognostic sensitivity (82%). The series approach combining either the Pugh score and indocyanine green test or the monoethylglycinexylidide and indocyanine green tests was associated with the highest specificity (96%/97%) and high predictive values of a positive result (81%/82%). These findings suggest that appropriate combinations of the studied flow-dependent dynamic liver function tests and the Pugh score could be useful in improving transplant candidate selection and the timing of transplantation.