Correlation between physiological assessment and outcome after liver transplantation

BACKGROUND: Critical shortages of organ donors for transplantation require appropriate utilization of this scarce resource. The purpose of this study was to assess whether use of physiological parameters of preliver transplan t recipients is helpful in determining eventual outcome. METHODS: Between October 1989 and June 1999, 215 liver transplants were per formed on 199 patients at the Vancouver Hospital nad Health Sciences Centre . Thirty-one patients undergoing transplantation between May 1993 and June 1994 were retrospectively evaluated to obtain a minimum 5-year follow-up. V ariables examined included pretransplant activation status (status 1, at ho me; status 2, hospitalized; status 3, admitted to intensive care; status 4, mechanical ventilation), simplified acute physiological score (SAPS), Acut e Physiology, Age, and Chronic Health Evaluation (APACHE) II, and APACHE II I scores at the time of transplantation. The scores were correlated to post transplant mortality and functional outcome. RESULTS: The 5-year mortality for status 1 patients was 14.3% versus 30% fo r patients listed as status 2 or greater (P = not significant). There were no significant differences in any of the physiological scoring assessments with regard to posttransplant mortality or functional assessment. Of the su rviving patients, 18 of 22 who were employed, in school, or active at home pretransplant returned to their pretransplant activity. CONCLUSIONS: Detailed physiological scoring systems are no more accurate in predicting outcome after liver transplant than current listing status para meters. (C) 2000 by Excerpta Medica, Inc.