| Early death or retransplantation in adults after orthotopic liver transplantation. Can outcome be predicted? | |
| | |
MedLine Citation:
|
PMID: 8165698 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Early, reliable outcome prediction after a liver transplant would help improve organ use by minimizing unnecessary retransplantations. At the same time, early intervention in those cases destined to fail may ameliorate the high morbidity and mortality associated with retransplantation. The purpose of this study was to analyze several parameters that have been identified in the past as being associated with patient and graft outcome, and to try to develop a model that would allow us to make predictions based on data available in the early postoperative period. A total of 148 patients were followed in a prospective, observational study. Graft failure was defined as patient death or retransplantation within 3 months of surgery. Preoperative variables studied included patient demographics, need for life support, presence of ascites, serum bilirubin, serum albumin, prothrombin time, serum creatinine, and the results of the cytotoxic crossmatch. During the first 5 postoperative days, standard measurements included serum transaminases, serum bilirubin, ketone body ratio, prothrombin time, factor V, and serum lactate. Oxygen consumption was measured shortly after surgery, once the patients had rewarmed to 36 degrees C. There were 131 successful transplants (88.5%) and 17 failures (11.5%). Most of the variables studied were found to be associated with outcome (by univariate analysis) at different points in the early postoperative period. However, receiver operating characteristic curve analysis showed that the predictive ability of even the best parameter was not adequate to make decisions on individual patients. Multivariate analysis, using stepwise logistic regression, yielded a model with an overall accuracy of 92.7%. Again, receiver operating characteristic curve analysis suggested that this model did not achieve the discriminating power needed for routine clinical use. We are still not able to accurately predict outcome in the early posttransplant period. We must be very careful when evaluating parameters, or scoring systems, that are said to accomplish this. It is especially important in this era of cost containment, with its renewed pressures to guide therapy based on our perceived understanding of a patient's future clinical course. |
| | |
Authors:
|
H R Doyle; I R Marino; N Jabbour; G Zetti; J McMichael; S Mitchell; J Fung; T E Starzl |
Related Documents
:
|
21467908 - A long-term follow-up study of acellular dermal matrix with thin autograft in burns pat... 15625658 - Utility of preoperative scores for predicting morbidity after cholecystectomy in patien... 21142738 - Treatment of the aged hand with injectable poly-l-lactic acid. 21334928 - Preferences of patients, their family caregivers and vascular surgeons in the choice of... 18275738 - A comparison of radiation exposure with the conventional versus mini c arm in orthopedi... 2210448 - Daytime reduction of gastro-oesophageal reflux after healing of oesophagitis and its va... |
Publication Detail:
|
Type: Journal Article; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
|
Title: Transplantation Volume: 57 ISSN: 0041-1337 ISO Abbreviation: Transplantation Publication Date: 1994 Apr |
Date Detail:
|
Created Date: 1994-05-20 Completed Date: 1994-05-20 Revised Date: 2011-07-20 |
Medline Journal Info:
|
Nlm Unique ID: 0132144 Medline TA: Transplantation Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 1028-36 Citation Subset: IM |
Affiliation:
|
Pittsburgh Transplantation Institute, University of Pittsburgh School of Medicine, Pennsylvania. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Bilirubin
/
blood Creatinine / blood Factor V / analysis Female Graft Rejection / etiology Humans Ketone Bodies / blood Lactates / blood Liver Transplantation / immunology, mortality* Male Middle Aged Postoperative Period Prothrombin Time Reoperation Transaminases / blood Treatment Outcome* |
| Grant Support | |
ID/Acronym/Agency:
|
DK 29961/DK/NIDDK NIH HHS; R01 DK029961-19/DK/NIDDK NIH HHS |
| Chemical | |
Reg. No./Substance:
|
0/Ketone Bodies; 0/Lactates; 60-27-5/Creatinine; 635-65-4/Bilirubin; 9001-24-5/Factor V; EC 2.6.1.-/Transaminases |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Role of adenosine in preservation by the two-layer method of ischemically damaged canine pancreas.
Next Document: Evaluation of sequential serum interleukin-6 levels in liver allograft recipients.