Al-Freah MAB, Moran C, Foxton MR, Agarwal K, Wendon JA, Heaton ND, Heneghan MA. Impact of comorbidity on waiting list and post-transplant outcomes in patients undergoing liver retransplantation. World J Hepatol 2017; 9(20): 884-895 [PMID: 28804571 DOI: 10.4254/wjh.v9.i20.884]
Corresponding Author of This Article
Dr. Michael A Heneghan, Consultant Hepatologist, Institute of Liver Studies, King’s College Hospital, Denmark Hill, London SE5 9RS, United Kingdom. michael.heneghan@nhs.net
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Jul 18, 2017; 9(20): 884-895 Published online Jul 18, 2017. doi: 10.4254/wjh.v9.i20.884
Table 1 Baseline characteristics for patients who had primary liver transplantation and those who had liver retransplantation
Variables
PLT (n = 1090)
LRT (n = 150)
P value
Demographic
Age
54 (18-82)
46 (18-72)
< 0.001
Gender (male, %)
736 (67.5)
80 (53.3)
0.001
Etiology
ALD (%)
345 (31.7)
18 (12.0)
< 0.001
Viral (%)
303 (27.8)
50 (33.3)
0.159
Cholestatic and autoimmune (%)
227 (20.8)
34 (22.7)
0.604
Clinical
Na, mmol/L
135 (116-151)
138 (118-150)
< 0.001
Creatinine, mg/dL
1.0 (0.4-6.8)
1.3 (0.7-8.3)
< 0.001
Bilirubin, mg/dL
2.7 (0.2-68.4)
4.7 (0.4-56.3)
< 0.001
INR
1.3 (0.8-5.0)
1.2 (0.8-13.0)
0.078
MELD
14 (6-40)
20 (6-40)
< 0.001
UKELD
55 (43-77)
56 (44-79)
0.041
Ascites (%)
669 (62.9)
38 (25.5)
< 0.001
Encephalopathy (%)
350 (33.0)
52 (34.9)
0.637
Table 2 Factors associated with waiting list mortality in liver retransplantation patients on univariate and multivariate Cox proportional hazard analysis
Variable
Univariate
Multivariate
HR
95%CI
P value
HR
95%CI
P value
Age > 60 yr
2.959
0.550-3.896
0.048
3.102
1.015-9.484
0.047
DM
1.587
0.499-5.042
0.434
Renal impairment
4.771
1.496-15.217
0.008
3.802
1.147-12.603
0.029
CCI continuous
3.121
1.589-6.130
0.001
2.688
1.222-5.912
0.014
CCI dichotomous
6.528
1.472-28.962
0.014
5.475
1.177-25.464
0.030
Hb, g/dL
0.755
0.545-1.047
0.092
Platelet count, × 109/mL
0.994
0.986-1.001
0.090
Bilirubin, mg/dL
1.012
0.979-1.045
0.481
Creatinine, mg/dL
3.200
1.888-5.421
< 0.001
2.691
1.261-5.740
0.010
INR
1.489
1.055-2.102
0.024
1.406
0.967-2.044
0.075
Encephalopathy
2.049
0.620-6.770
0.239
Ascites
2.781
1.006-7.682
0.049
MELD
1.154
1.067-1.248
< 0.001
2.691
1.261-5.740
0.01
MELD ≥ 18
3.827
1.190-12.315
0.024
4.369
1.255-15.215
0.021
Na, mmol/L
0.945
0.870-1.027
0.180
UKELD
1.121
1.029-1.220
0.009
1.117
1.037-1.204
0.003
Table 3 Univariate and multivariate analysis of factors associated with 1-year post-transplant patient and graft survival of retransplanted patients on Cox proportional hazard analysis
Variable
Patient survival
Graft survival
HR
95%CI
P value
HR
95%CI
P value
Univariate analysis
Age
0.796
0.973-1.021
0.997
0.992
0.969-1.016
0.515
Early graft dysfunction
2.143
0.919-4.998
0.078
1.788
0.776-4.123
0.173
DM
2.242
0.961-5.228
0.062
2.004
0.869-4.618
0.103
Renal impairment
4.385
2.133-9.017
< 0.001
3.494
1.759-6.941
< 0.001
CCI continuous
3.344
1.949-5.738
< 0.001
2.755
1.638-4.633
< 0.001
CCI dichotomous
3.56
1.691-7.493
0.001
2.751
1.377-5.494
0.004
Pre-LRT mechanical ventilation
3.044
1.461-6.342
0.003
2.456
1.210-4.983
0.013
Pre-LRT vasopressor support
4.714
2.239-9.928
< 0.001
3.618
1.758-7.443
< 0.001
Pre-LRT renal replacement therapy
4.233
2.029-8.829
< 0.001
3.271
1.630-6.562
0.001
Transplant from ICU
2.744
1.318-5.712
0.007
2.101
1.049-4.206
0.036
MELD score ≥ 18
4.714
2.239-9.928
0.009
3.105
1.399-6.890
0.005
Encephalopathy at LRT
2.593
1.213-5.544
0.014
2.28
1.121-4.639
0.023
Hb, g/dL
0.791
0.629-0.994
0.044
0.792
0.636-0.985
0.037
ABO mismatch
2.37
1.015-5.532
0.046
2.338
1.053-5.190
0.037
Cold ischemia time (h)
1.113
0.987-1.255
0.082
1.081
0.962-1.216
0.191
DRI
0.68
0.236-1.963
0.476
0.693
0.250-1.918
0.476
DRI > 1.8
1.736
0.772-3.902
0.180
1.67
0.747-3.737
0.212
Multivariate analysis
Renal impairment
3.215
1.147-12.603
0.005
2.543
1.160-5.573
0.020
CCI Continuous
2.823
1.563-5.101
0.001
2.350
1.331-4.148
0.003
CCI Dichotomous
2.87
1.306-6.307
0.009
2.223
1.067-4.633
0.033
Pre-LRT mechanical ventilation
2.52
1.126-5.637
0.024
2.099
0.968-4.552
0.060
Pre-LRT vasopressor support
4.004
1.554-10.314
0.004
3.023
1.216-7.514
0.017
Pre-LRT renal replacement therapy
2.691
1.261-5.740
0.01
2.441
1.107-5.383
0.027
Transplant from ICU
1.859
0.794-4.354
0.153
1.437
0.640-3.230
0.380
MELD score ≥ 18
2.506
1.044-6.018
0.04
2.512
1.098-5.743
0.029
Encephalopathy at LRT
1.922
0.856-4.315
0.113
1.626
0.752-3.515
0.217
Hb, g/dL at LRT
0.883
0.694-1.125
0.314
0.883
0.698-1.116
0.297
ABO mismatch
1.795
0.739-4363
0.197
1.827
0.791-4.220
0.158
Table 4 Comparison of prognostic variables according to time interval of liver retransplantation
Time between transplants (d)
0-7 (n = 19)
8-30 (n = 16)
> 30 (n = 86)
P value
Age
54 (18-67)
44 (20-63)
43 (19-70)
0.086
Transplant MELD
22 (10-40)
17 (8-36)
17 (6-31)
0.104
CCI ≥ 1, n (%)
10 (71)
11 (61)
44 (49)
0.095
Indication, n (%)
Early graft dysfunction
14 (74)
2 (13)
2 (2)
< 0.001
Graft rejection
0 (0)
1 (6)
30 (35)
< 0.001
Vascular
5 (26)
13 (81)
23 (27)
< 0.001
Disease recurrence
0 (0)
0 (0)
24 (28)
0.001
Other indications
0 (0)
0 (0)
7 (8)
0.106
Citation: Al-Freah MAB, Moran C, Foxton MR, Agarwal K, Wendon JA, Heaton ND, Heneghan MA. Impact of comorbidity on waiting list and post-transplant outcomes in patients undergoing liver retransplantation. World J Hepatol 2017; 9(20): 884-895