Iron metabolism imbalance at the time of listing increases overall and infectious mortality after liver transplantation

Table 1 Baseline patient characteristics

Variable	n = 553
Age, yr	55 (49-60.5)
Sex male/female	414 (74.9)/139 (25.1)
BMI, kg/m²	26.2 (23.3-29.7)
Iron metabolism
Serum iron, µmol/L	21.9 (1.6; 57.9)
Transferrin, g/L	2.10 (1.5-2.5)
Transferrin saturation, %	43.6 (25.1-74.5)
Transferrin saturation > 75%	136 (24.6)
Serum ferritin, µg/L	241 (75.5-593.5)
< 100	168 (30.4)
100-400	185 (33.5)
> 400	200 (36.2)
Cirrhosis etiology
Alcohol	340 (61.5)
Viral hepatitis C	89 (16.1)
Viral hepatitis B	18 (3.3)
Primary sclerosing cholangitis	20 (3.6)
Primary biliary cholangitis	12 (2.2)
Auto-immune	10 (1.8)
Hemochromatosis	17 (3.0)
Others	47 (8.4)
Hepatocellular carcinoma	214 (38.7)
Child pugh score
A	206 (39.1)
B	158 (30.0)
C	163 (31.0)
MELD	15.1 (10.6-20.7)
Donor age, yr	49 (37-62)
Donor BMI, kg/m2	24.3 (21.9-27.6)
Cold ischemia, minutes	592 (446-723)
Perioperative transfusion
Packed red cell, n	5 (2-8)
Fresh frozen plasma, n	6 (2-9)
ICU length of stay, d	4 (3-7)

For categorical variables, data are given as n (%). For continuous variables, data are given as median (range). BMI: Body mass index; ICU: Intensive care unit; MELD: Model of End-Stage Liver Disease.

Table 2 Patient outcomes

	n (%)
Dead	196
Lost to follow up	5
Causes of death
Cancer	41 (20.92)
Infection	38 (19.39)
Recurrence of initial liver disease	30 (15.31)
Graft failure	12 (6.12)
Cardio vascular event	28 (14.29)
Others	31 (15.82)
Undetermined	16 (8.16)

Table 3 Cox multiple regression analysis for overall mortality

Parameters	HR (95%CI)	P value
Hepatocellular carcinoma (yes/no)	1.58 (1.15; 2.16)	0.004
eGFR CKD EPI Cystatin C (mL/min)	0.99 (0.98; 0.99)	0.01
Cirrhosis aetiology (HCV as reference)		0.028
Alcohol	0.57 (0.39; 0.83)	0.003
Hepatitis B virus	0.50 (0.19; 1.28)	0.14
Other	0.66 (0.41; 1.08)	0.10
Transferrin saturation > 75%	1.73 (1.14; 2.63)	0.01
Ferritin (100-400 µg/L as reference)		0.009
< 100 µg/L	1.62 (1.12; 2.35)	0.01
> 400 µg/L	0.90 (0.59; 1.37)	0.63
Packed red blood cell (per unit)	1.05 (1.03; 1.08)	< 0.001

CI: Confidence interval; HCV: Hepatitis C virus; HR: Hazard ratio; ICU: Intensive care unit.

Table 4 Multivariate analysis for risk factors of infection associated death

Parameters	HR (95%CI)	P value
Transferrin saturation > 75%	3.06 (1.13; 8.23)	0.02
Ferritin (100-400 µg/L as reference)		0.02
< 100 µg/L	1.74 (0.77; 3.93)	0.17
> 400 µg/L	0.35 (0.12; 0.98)	0.48
eGFR CKD EPI Cystatin C (mL/min)	0.98 (0.97; 0.99)	0.03
ICU length of stay (d)	1.02 (1.01; 1.03)	< 0.01

CI: Confidence interval; HR: Hazard ratio; ICU: Intensive care unit.