Predictors of Survival After Liver Transplantation in Patients With the Highest Acuity (MELD ≥40).
Ann Surg
; 272(3): 458-466, 2020 09 01.
Article
em En
| MEDLINE
| ID: mdl-32740239
ABSTRACT
OBJECTIVE:
To identify factors that accurately predict 1-year survival for liver transplant recipients with a MELD score ≥40.BACKGROUND:
Although transplant is beneficial for patients with the highest acuity (MELD ≥40), mortality in this group is high. Predicting which patients are likely to survive for >1 year would be medically and economically helpful.METHODS:
The Scientific Registry of Transplant Recipients database was reviewed to identify adult liver transplant recipients from 2002 through 2016 with MELD score ≥40 at transplant. The relationships between 44 recipient and donor factors and 1-year patient survival were examined using random survival forests methods. Variable importance measures were used to identify the factors with the strongest influence on survival, and partial dependence plots were used to determine the dependence of survival on the target variable while adjusting for all other variables.RESULTS:
We identified 5309 liver transplants that met our criteria. The overall 1-year survival of high-acuity patients improved from 69% in 2001 to 87% in 2016. The strongest predictors of death within 1 year of transplant were patient on mechanical ventilator before transplantation, prior liver transplant, older recipient age, older donor age, donation after cardiac death, and longer cold ischemia.CONCLUSIONS:
Liver transplant outcomes continue to improve even for patients with high medical acuity. Applying ensemble learning methods to recipient and donor factors available before transplant can predict survival probabilities for future transplant cases. This information can be used to facilitate donor/recipient matching and to improve informed consent.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Doadores de Tecidos
/
Obtenção de Tecidos e Órgãos
/
Transplante de Fígado
/
Isquemia Fria
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Doença Hepática Terminal
/
Transplantados
Tipo de estudo:
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Ann Surg
Ano de publicação:
2020
Tipo de documento:
Article