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Analysis of liver transplant outcomes for United Network for Organ Sharing recipients 60 years old or older identifies multiple model for end-stage liver disease-independent prognostic factors.
Liver Transpl. 2010 Aug; 16(8):950-9.LT

Abstract

Older recipient age is associated with worse posttransplant survival. Although the median age of liver disease patients undergoing orthotopic liver transplantation (OLT) continues to rise, prognostic factors for posttransplant survival specific to older patients have not been defined. To address this issue, the United Network for Organ Sharing/Organ Procurement and Transplantation Network outcome database was searched to identify prognostic factors for the 8070 liver recipients 60 years old or older who underwent transplantation from 1994 to 2005. Prognostic factors were assessed with univariate analysis and multivariate modeling. The 5 strongest prognostic variables (ventilator status, diabetes mellitus, hepatitis C virus, creatinine levels >/=1.6 mg/dL, and recipient and donor age >or=120 years) were aggregated to define a novel older recipient prognostic score (ORPS). The overall 1- and 5-year posttransplant survival rates were 83% and 67%, respectively. The risk model, created by the assignment of 1 point to each ORPS factor, stratified patient outcomes into distinct prognostic groups at the 1-, 3-, and 5-year posttransplant time points (P < 0.001). The 5-year survival rates for patients with ORPS values of 0, 1, and 2 points were 75%, 69%, and 58%, respectively. Patients who underwent transplantation with an ORPS > 2 points consistently experienced 5-year survival rates of less than 50%. In conclusion, in liver transplant recipients 60 years old or older, the ORPS was able to predict significant and clinically relevant differences in posttransplant survival. By optimization of donor selection for recipients over the age of 60 years, clinical utilization of the ORPS model may enhance organ utilization for all patients awaiting OLT.

Authors+Show Affiliations

Division of Transplantation, Department of Surgery, Weill Cornell Medical College, Methodist Hospital, Houston, TX 77030, USA. taaloia@tmhs.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20589647

Citation

Aloia, Thomas A., et al. "Analysis of Liver Transplant Outcomes for United Network for Organ Sharing Recipients 60 Years Old or Older Identifies Multiple Model for End-stage Liver Disease-independent Prognostic Factors." Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, vol. 16, no. 8, 2010, pp. 950-9.
Aloia TA, Knight R, Gaber AO, et al. Analysis of liver transplant outcomes for United Network for Organ Sharing recipients 60 years old or older identifies multiple model for end-stage liver disease-independent prognostic factors. Liver Transpl. 2010;16(8):950-9.
Aloia, T. A., Knight, R., Gaber, A. O., Ghobrial, R. M., & Goss, J. A. (2010). Analysis of liver transplant outcomes for United Network for Organ Sharing recipients 60 years old or older identifies multiple model for end-stage liver disease-independent prognostic factors. Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, 16(8), 950-9. https://doi.org/10.1002/lt.22098
Aloia TA, et al. Analysis of Liver Transplant Outcomes for United Network for Organ Sharing Recipients 60 Years Old or Older Identifies Multiple Model for End-stage Liver Disease-independent Prognostic Factors. Liver Transpl. 2010;16(8):950-9. PubMed PMID: 20589647.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Analysis of liver transplant outcomes for United Network for Organ Sharing recipients 60 years old or older identifies multiple model for end-stage liver disease-independent prognostic factors. AU - Aloia,Thomas A, AU - Knight,Richard, AU - Gaber,A Osama, AU - Ghobrial,R Mark, AU - Goss,John A, PY - 2010/7/1/entrez PY - 2010/7/1/pubmed PY - 2010/11/17/medline SP - 950 EP - 9 JF - Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society JO - Liver Transpl VL - 16 IS - 8 N2 - Older recipient age is associated with worse posttransplant survival. Although the median age of liver disease patients undergoing orthotopic liver transplantation (OLT) continues to rise, prognostic factors for posttransplant survival specific to older patients have not been defined. To address this issue, the United Network for Organ Sharing/Organ Procurement and Transplantation Network outcome database was searched to identify prognostic factors for the 8070 liver recipients 60 years old or older who underwent transplantation from 1994 to 2005. Prognostic factors were assessed with univariate analysis and multivariate modeling. The 5 strongest prognostic variables (ventilator status, diabetes mellitus, hepatitis C virus, creatinine levels >/=1.6 mg/dL, and recipient and donor age >or=120 years) were aggregated to define a novel older recipient prognostic score (ORPS). The overall 1- and 5-year posttransplant survival rates were 83% and 67%, respectively. The risk model, created by the assignment of 1 point to each ORPS factor, stratified patient outcomes into distinct prognostic groups at the 1-, 3-, and 5-year posttransplant time points (P < 0.001). The 5-year survival rates for patients with ORPS values of 0, 1, and 2 points were 75%, 69%, and 58%, respectively. Patients who underwent transplantation with an ORPS > 2 points consistently experienced 5-year survival rates of less than 50%. In conclusion, in liver transplant recipients 60 years old or older, the ORPS was able to predict significant and clinically relevant differences in posttransplant survival. By optimization of donor selection for recipients over the age of 60 years, clinical utilization of the ORPS model may enhance organ utilization for all patients awaiting OLT. SN - 1527-6473 UR - https://www.unboundmedicine.com/medline/citation/20589647/Analysis_of_liver_transplant_outcomes_for_United_Network_for_Organ_Sharing_recipients_60_years_old_or_older_identifies_multiple_model_for_end_stage_liver_disease_independent_prognostic_factors_ L2 - https://doi.org/10.1002/lt.22098 DB - PRIME DP - Unbound Medicine ER -