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• W2023407727 abstract "29 Hepatic retransplantation is an inefficient and costly use of both medical resources and scarce donor organs. Since long-term survival approaches 50%, universal proscription of multiple grafts is unjustified. It may be possible however to identify subsets of patients with such poor expected survival as to make them unsuitable candidates for retransplantation. To this end, we analyzed 150 patients retransplanted at UCLA for preoperative factors that might impact patient survival. Of 29 variables studied, 9 proved significant using Kaplan-Meier bivariate statistical analysis. Of these, 5 had independent prognostic significance in Cox multivariate regression: 1) age, 2) Preoperative ventilator dependence (vent.), 3) serum creatinine (Cr.), 4) serum bilirubin (Tbili.), and 5) duration of organ cold ischemia. Using these variables, survival can be estimated by the equation: Estimated survival = .611x, where x = e(mortality score) and mortality score = (.726 × ischemia + .561 × vent. + .0292 × Tbili. + .202 × Cr. + .526 × age group - 1.6837). This formula can be used to identify patients with unacceptable expected outcome. For example, a risk score of > 2.66 predicts a 1 year survival of 27 +/-13%. Next, a simplified version of this model was developed in which each variable was given equal weight and assigned a value of 0 or 1: Vent. No=0, Yes=1, Age<18=0, ≥18=1, Ischemia <12 hrs.=0, > 12 hrs.=1, Cr.< 2 =0, and ≥2 =1, Tbili.<15=0, and ≥15 =1). Patients were classified into 5 risk classes (0,1,2,3,4) according to the sum of these values (class 4 = score 4 or 5). Observed survival correlated with risk class for the 150 UCLA patients (fig. 1). The model was validated with a 2nd independent cohort consisting of 1927 retransplanted patients from the UNOS data registry (fig. 2). Both UCLA and UNOS patients scoring 4 or 5 (of possible 5) exhibited 1 year survival <40%. We believe that this model will assist in selection of patients appropriate for hepatic retransplantation.FigureFigure" @default.
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• W2023407727 date "1998-10-01" @default.
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• W2023407727 title "A simple model to predict survival following hepatic retransplantation" @default.
• W2023407727 doi "https://doi.org/10.1097/00007890-199810270-00059" @default.
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