To formulate a model predicting survival after liver retransplantation, we analyzed in detail the last 150 cases of hepatic retransplantation at UCLA. Cox proportional hazards regression analysis identified five variables that demonstrated independent simultaneous prognostic value in estimating patient survival after retransplantation: (1) age group (pediatric or adult), (2) recipient requiring preoperative mechanical ventilation, (3) donor organ cold ischemia ≥12 hr, (4) preoperative serum creatinine, and (5) preoperative serum total bilirubin. The Cox regression equation that predicts survival based on these covariates was simplified by assigning individual patients a risk classification based on a 5-point scoring system. We demonstrate that this system can be employed to identify a subgroup of patients in which the expected outcome is too poor to justify retransplantation. These findings may assist in the rational selection of patients suitable for retransplantation.
Dumont-UCLA Center for Liver Transplantation and Surgery, Department of Surgery and Department of Biomathematics, UCLA Medical Center, Los Angeles, California and Transplantation Services, Baylor University Medical Center, Dallas, Texas
1Presented in abstract form at the 17th Annual Meeting of the American Society of Transplant Physicians, May 9-13, 1998, Chicago, IL.
2Dumont-UCLA Center for Liver Transplantation and Surgery, Department of Surgery.
3Address correspondence to: J.F. Markmann, Dumont-UCLA Center for Liver Transplantation and Surgery, Department of Surgery, UCLA Medical Center, 77-120 CHS, Los Angeles, CA 90095-7054.
4Department of Biomathematics, UCLA Medical Center.
5Transplantation Services, Baylor University Medical Center.
6Department of Surgery Hospital of the University of Pennsylvania.
Received 26 May 1998.
Accepted 27 October 1998.