Pretransplant Prediction of Prognosis After Liver... : Hepatology (original) (raw)

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Pretransplant Prediction of Prognosis After Liver Transplantation in Primary Sclerosing Cholangitis Using A Cox Regression Model

Neuberger, James M.D.*,1; Gunson, Bridget1; Komolmit, Piyawat2; Davies, Mervyn H.2; Christensen, Erik3

1_Liver and Hepatobiliary Unit, The Queen Elizabeth Hospital, Edgbaston, Birmingham, UK_

2_The Liver Unit, St. James's University Hospital, Leeds, UK_

3_Clinic of Internal Medicine I, Bispebjerg University Hospital, Bispebjerg Bakke 23, Copenhagen, Denmark_

* The Liver and Hepatobiliary Unit, 3rd Floor, Nuffield House, The Queen Elizabeth Hospital, Edgbaston, Birmingham B15 2TH, UK. fax: 44 (0) 121 627 2449; E-mail: [email protected].

Received: 10 August 1998; Accepted: 2 February 1999

Abstract

Liver transplantation remains the only treatment for patients with end–stage primary sclerosing cholangitis (PSC); however, selection criteria for the procedure and its timing remains uncertain. The aim of this study was to identify pretransplant variables associated with survival after transplantation and to devise a Cox regression model for prediction of post–transplant survival. We studied 118 patients transplanted for PSC at the Queen Elizabeth Hospital, Birmingham, UK, being followed for up to 9¼ years after the procedure. The association between pretransplant data and the post–transplant survival up to 1 year was studied using the logrank test (univariate analyses) and Cox multiple regression analysis. Univariate analyses showed the following variables to be associated with a decreased post–transplant survival: high serum creatinine, high serum bilirubin, biliary tree malignancy, previous upper abdominal surgery, hepatic encephalopathy, ascites, and Crohn's disease, whereas ulcerative colitis was associated with increased post–transplant survival (all P ≤ .05). The final multiple Cox regression model included the following significant variables: inflammatory bowel disease, ascites, previous upper abdominal surgery, serum creatinine, and biliary tree malignancy (all P < .03). Biliary tree malignancy could be omitted from the Cox model with only slight loss of information. The results were validated using the data of 30 independent PSC patients from another center. These results can improve selection of patients with PSC for liver transplantation. The developed prognostic model for transplantation can be used in parallel with previously published prognostic models for nontransplantation. The obtained prognostic estimates will provide additional information that is useful for optimal timing of liver transplantation in the individual patient