February 4, 2012

A Score Predicting Survival After Liver Retransplantation for Hepatitis C Virus Cirrhosis.

Transplantation. 2012 Jan 19. [Epub ahead of print]

Andres A, Gerstel E, Combescure C, Asthana S, Merani S, Majno P, Berney T, Morel P, Kneteman N, Mentha G, Toso C.

1Abdominal and Transplantation Surgery, Department of Surgery, University Hospital Geneva, Switzerland. 2Clinical Epidemiology, University Hospital Geneva, Switzerland and the Division of Internal Medicine, University Hospital Geneva, Switzerland. 3Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.

BACKGROUND: Approximately one fourth of patients transplanted for hepatitis C virus (HCV)-induced liver failure progress to cirrhosis within 5 years, potentially requiring retransplantation. Although the relisting decision can be difficult in these patients, a score could help in selection of candidates with the best potential outcomes.

METHODS: A total of 1422 HCV-positive patients having undergone a retransplantation were included in this registry-based study. A multivariate Cox regression was performed, and an Akaike procedure was applied to design a score predicting survival after retransplantation and to allow an internal validation. Retained variables were donor age (DnAge), serum creatinine (Creat), International Normalized Ratio (INR), and serum albumin (Alb) at the second transplantation, recipient age (RecAge) at the first transplantation, and the interval between both transplantations (Int).

RESULTS: The score was designed as 0.23×DnAge+4.86×log Creat-2.45×log Int+2.69×INR+0.10×RecAge-3.27× Alb+40. The receiver operating characteristic area under curve was 0.643 at 3 years, and survivals were 71%, 56%, and 37% for scores <30, 30 to 40, and >40, respectively (log rank <0.0001).

CONCLUSIONS: Overall, the proposed score is specifically designed for HCV-positive patients, accurately predicts survival after a liver retransplantation, and is helpful in the selection of candidates with the best potential outcomes.


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