3-month and 12-month mortality after first liver transplant in adults in Europe

Predictive models for outcome

Andrew K. Burroughs, Caroline A. Sabin, Keith Rolles, Valerie Delvart, Vincent Karam, John Buckels, John G. O'Grady, Denis Castaing, Jurgen Klempnauer, Neville Jamieson, Peter Neuhaus, Jan Lerut, Jean De Ville De Goyet, Stephen Pollard, Mauro Salizzoni, Xavier Rogiers, Ferdinand Muhlbacher, Juan Carlos Garcia Valdecasas, Christopher Broelsch, Daniel Jaeck & 3 others Joaquin Berenguer, Enrique Moreno Gonzalez, Rene Adam

Research output: Contribution to journalArticle

245 Citations (Scopus)

Abstract

Background: Mortality after liver transplantation depends on heterogeneous recipient and donor factors. Our aim was to assess risk of death and to develop models to help predict mortality after liver transplantation. Methods: We analysed data from 34 664 first adult liver transplants from the European Liver Transplant Registry to identify factors associated with mortality at 3-months (n=21 605 in training dataset) and 12-months (n=18 852 in training dataset) after transplantation. We used multivariable logistic regression models to generate mortality scores for each individual, and assessed model discrimination and calibration on an independent validation dataset (n=9489 for 3-month model and n=8313 for 12-month model). Findings: 2540 of 21 605 (12%) individuals in the 3-month training sample had died by 3 months. Compared with those transplanted in 2000-03, those transplanted earlier had a higher risk of death. Increased mortality at 3-months post-transplantation was associated with acute liver failure (adjusted odds ratio 1·61), donor age older than 60 years (1·16), compatible (1·22) or incompatible (2·07) donor-recipient blood group, older recipient age (1·12 per 5 years), split or reduced graft (1·96), total ischaemia time of longer than 13 h (1·38), and low United Network for Organ Sharing score (score 1: 2·43; score 2: 1·67). However, cirrhosis with hepatocellular carcinoma, alcohol cirrhosis, hepatitis C or primary biliary cirrhosis, donor age 40 years or younger, or less, hepatitis B, and larger size of transplant centre (≥70 transplants per year) were associated with improved early outcomes. The 3-month mortality score discriminated well between those who did and did not die in the validation sample (C statistic=0·688). We noted similar findings for 12-month mortality, although deaths were generally underestimated at this timepoint. Interpretation: The 3-month and 12-month mortality models can be effectively used to assess outcomes both within and between centres. Furthermore, the models provide a means of assessing the risk of post-transplantation mortality, giving clinicians important data on which to base strategic decisions about transplant policy in particular individuals or groups.

Original languageEnglish
Pages (from-to)225-232
Number of pages8
JournalLancet
Volume367
Issue number9506
DOIs
Publication statusPublished - Jan 21 2006

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Transplants
Mortality
Liver
Transplantation
Liver Transplantation
Fibrosis
Logistic Models
Acute Liver Failure
Biliary Liver Cirrhosis
Hepatitis C
Blood Group Antigens
Hepatitis B
Calibration
Registries
Hepatocellular Carcinoma
Ischemia
Odds Ratio
Alcohols
Datasets

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Burroughs, A. K., Sabin, C. A., Rolles, K., Delvart, V., Karam, V., Buckels, J., ... Adam, R. (2006). 3-month and 12-month mortality after first liver transplant in adults in Europe: Predictive models for outcome. Lancet, 367(9506), 225-232. https://doi.org/10.1016/S0140-6736(06)68033-1

3-month and 12-month mortality after first liver transplant in adults in Europe : Predictive models for outcome. / Burroughs, Andrew K.; Sabin, Caroline A.; Rolles, Keith; Delvart, Valerie; Karam, Vincent; Buckels, John; O'Grady, John G.; Castaing, Denis; Klempnauer, Jurgen; Jamieson, Neville; Neuhaus, Peter; Lerut, Jan; De Ville De Goyet, Jean; Pollard, Stephen; Salizzoni, Mauro; Rogiers, Xavier; Muhlbacher, Ferdinand; Garcia Valdecasas, Juan Carlos; Broelsch, Christopher; Jaeck, Daniel; Berenguer, Joaquin; Gonzalez, Enrique Moreno; Adam, Rene.

In: Lancet, Vol. 367, No. 9506, 21.01.2006, p. 225-232.

Research output: Contribution to journalArticle

Burroughs, AK, Sabin, CA, Rolles, K, Delvart, V, Karam, V, Buckels, J, O'Grady, JG, Castaing, D, Klempnauer, J, Jamieson, N, Neuhaus, P, Lerut, J, De Ville De Goyet, J, Pollard, S, Salizzoni, M, Rogiers, X, Muhlbacher, F, Garcia Valdecasas, JC, Broelsch, C, Jaeck, D, Berenguer, J, Gonzalez, EM & Adam, R 2006, '3-month and 12-month mortality after first liver transplant in adults in Europe: Predictive models for outcome', Lancet, vol. 367, no. 9506, pp. 225-232. https://doi.org/10.1016/S0140-6736(06)68033-1
Burroughs, Andrew K. ; Sabin, Caroline A. ; Rolles, Keith ; Delvart, Valerie ; Karam, Vincent ; Buckels, John ; O'Grady, John G. ; Castaing, Denis ; Klempnauer, Jurgen ; Jamieson, Neville ; Neuhaus, Peter ; Lerut, Jan ; De Ville De Goyet, Jean ; Pollard, Stephen ; Salizzoni, Mauro ; Rogiers, Xavier ; Muhlbacher, Ferdinand ; Garcia Valdecasas, Juan Carlos ; Broelsch, Christopher ; Jaeck, Daniel ; Berenguer, Joaquin ; Gonzalez, Enrique Moreno ; Adam, Rene. / 3-month and 12-month mortality after first liver transplant in adults in Europe : Predictive models for outcome. In: Lancet. 2006 ; Vol. 367, No. 9506. pp. 225-232.
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T1 - 3-month and 12-month mortality after first liver transplant in adults in Europe

T2 - Predictive models for outcome

AU - Burroughs, Andrew K.

AU - Sabin, Caroline A.

AU - Rolles, Keith

AU - Delvart, Valerie

AU - Karam, Vincent

AU - Buckels, John

AU - O'Grady, John G.

AU - Castaing, Denis

AU - Klempnauer, Jurgen

AU - Jamieson, Neville

AU - Neuhaus, Peter

AU - Lerut, Jan

AU - De Ville De Goyet, Jean

AU - Pollard, Stephen

AU - Salizzoni, Mauro

AU - Rogiers, Xavier

AU - Muhlbacher, Ferdinand

AU - Garcia Valdecasas, Juan Carlos

AU - Broelsch, Christopher

AU - Jaeck, Daniel

AU - Berenguer, Joaquin

AU - Gonzalez, Enrique Moreno

AU - Adam, Rene

PY - 2006/1/21

Y1 - 2006/1/21

N2 - Background: Mortality after liver transplantation depends on heterogeneous recipient and donor factors. Our aim was to assess risk of death and to develop models to help predict mortality after liver transplantation. Methods: We analysed data from 34 664 first adult liver transplants from the European Liver Transplant Registry to identify factors associated with mortality at 3-months (n=21 605 in training dataset) and 12-months (n=18 852 in training dataset) after transplantation. We used multivariable logistic regression models to generate mortality scores for each individual, and assessed model discrimination and calibration on an independent validation dataset (n=9489 for 3-month model and n=8313 for 12-month model). Findings: 2540 of 21 605 (12%) individuals in the 3-month training sample had died by 3 months. Compared with those transplanted in 2000-03, those transplanted earlier had a higher risk of death. Increased mortality at 3-months post-transplantation was associated with acute liver failure (adjusted odds ratio 1·61), donor age older than 60 years (1·16), compatible (1·22) or incompatible (2·07) donor-recipient blood group, older recipient age (1·12 per 5 years), split or reduced graft (1·96), total ischaemia time of longer than 13 h (1·38), and low United Network for Organ Sharing score (score 1: 2·43; score 2: 1·67). However, cirrhosis with hepatocellular carcinoma, alcohol cirrhosis, hepatitis C or primary biliary cirrhosis, donor age 40 years or younger, or less, hepatitis B, and larger size of transplant centre (≥70 transplants per year) were associated with improved early outcomes. The 3-month mortality score discriminated well between those who did and did not die in the validation sample (C statistic=0·688). We noted similar findings for 12-month mortality, although deaths were generally underestimated at this timepoint. Interpretation: The 3-month and 12-month mortality models can be effectively used to assess outcomes both within and between centres. Furthermore, the models provide a means of assessing the risk of post-transplantation mortality, giving clinicians important data on which to base strategic decisions about transplant policy in particular individuals or groups.

AB - Background: Mortality after liver transplantation depends on heterogeneous recipient and donor factors. Our aim was to assess risk of death and to develop models to help predict mortality after liver transplantation. Methods: We analysed data from 34 664 first adult liver transplants from the European Liver Transplant Registry to identify factors associated with mortality at 3-months (n=21 605 in training dataset) and 12-months (n=18 852 in training dataset) after transplantation. We used multivariable logistic regression models to generate mortality scores for each individual, and assessed model discrimination and calibration on an independent validation dataset (n=9489 for 3-month model and n=8313 for 12-month model). Findings: 2540 of 21 605 (12%) individuals in the 3-month training sample had died by 3 months. Compared with those transplanted in 2000-03, those transplanted earlier had a higher risk of death. Increased mortality at 3-months post-transplantation was associated with acute liver failure (adjusted odds ratio 1·61), donor age older than 60 years (1·16), compatible (1·22) or incompatible (2·07) donor-recipient blood group, older recipient age (1·12 per 5 years), split or reduced graft (1·96), total ischaemia time of longer than 13 h (1·38), and low United Network for Organ Sharing score (score 1: 2·43; score 2: 1·67). However, cirrhosis with hepatocellular carcinoma, alcohol cirrhosis, hepatitis C or primary biliary cirrhosis, donor age 40 years or younger, or less, hepatitis B, and larger size of transplant centre (≥70 transplants per year) were associated with improved early outcomes. The 3-month mortality score discriminated well between those who did and did not die in the validation sample (C statistic=0·688). We noted similar findings for 12-month mortality, although deaths were generally underestimated at this timepoint. Interpretation: The 3-month and 12-month mortality models can be effectively used to assess outcomes both within and between centres. Furthermore, the models provide a means of assessing the risk of post-transplantation mortality, giving clinicians important data on which to base strategic decisions about transplant policy in particular individuals or groups.

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