Preoperative factors associated with outcome and their impact on resource use in 1148 consecutive primary liver transplants

Background. Hepatic transplantation is a highly effective but costly treatm ent for end-stage hepatic dysfunction. One approach to improve efficiency i n the use of scarce organs for transplantation is to identify preoperative factors that are associated with poor outcome posttransplantation. This may assist both in selecting patients optimal for transplantation and in ident ifying strategies to improve survival. Methods. In the present work, we retrospectively reviewed consecutive liver transplants performed at the University of California at Los Angeles durin g a 6-year period and determined preoperative variables that were associate d with outcome in primary grafts. In addition, we used the hospital's cost accounting database to determine the impact of these variables on the degre e of resource use by high-risk patients. Results. We found five variables to have independent prognostic value in pr edicting graft survival after primary liver transplantation: (1) donor age, (2) recipient age, (3) donor sodium, (4) recipient creatinine, and (5) rec ipient ventilator requirement pretransplant. Recipient ventilator requireme nt and elevated creatinine were associated with significant increases in re source use during the transplant admission. Conclusions. Patients at high risk for graft failure and costly transplants can be identified preoperatively by a set of parameters that are readily a vailable, noninvasive, and inexpensive. Selection of recipients on the basi s of these data would improve the efficiency of liver transplantation and r educe its cost.