Graft survival and its determinants: a 3 year national experience with liver transplantation in Israel

• Published in: The Israel Medical Association journal 2006-06, Vol.8 (6), p.400-405
• Main Authors: Ekka-Zohar, Anat, Zitser-Gurevich, Yana, Mandel, Micha, Weiss-Salz, Inbal, Nir, Sharon, Mor, Eitan, Richard, Nakash, Merhav, Hadar, Bruck, Rafael, Simchen, Elisheva
• Format: Article
• Language: English
• Subjects: Adult; Aged; Diagnosis-Related Groups; Female; Graft Survival; Humans; Israel - epidemiology; Liver Failure - surgery; Liver Transplantation - statistics & numerical data; Logistic Models; Male; Medical Records; Middle Aged; Multivariate Analysis; Odds Ratio; Retrospective Studies; Risk Factors; Severity of Illness Index; Survival Analysis
• ISSN: 1565-1088

There is a dearth of organs for liver transplantation in Israel. Enhancing our understanding of factors affecting graft survival in this country could help optimize the results of the transplant operation. To report 3 years national experience with orthotopic liver transplantation, and to evaluate patient and perioperative risk factors that could affect 1 year graft survival. The study related to all 124 isolated adult liver transplantations performed in Israel between October 1997 and October 2000. Data were abstracted from the medical records. One-year graft survival was described using the Kaplan-Meier survival curve and three multivariate logistic regression models were performed: one with preoperative case-mix factors alone, and the other two with the addition of donor and operative factors respectively. Of the 124 liver transplantations performed, 32 failed (25.8%). The 1 year survival was lower than rates reported from both the United States and Europe but the difference was not significant. Of the preoperative risk factors, recipient age > 60 years, critical condition prior to surgery, high serum bilirubin and serum hemoglobin < or = 10 g/dl were independently associated with graft failure, adjusting for all the other factors that entered the logistic regression equation. Extending the model to include donor and operative factors raised the C-statistic from 0.79 to 0.87. Donor age > or = 40, cold ischemic time > 10 hours and a prolonged operation (> 10 hours) were the additional predictors for graft survival. A MELD score of over 18 was associated with a sixfold increased risk for graft failure (odds ratio = 6.5, P = 0.001). Graft survival in Israel is slightly lower than that reported from the U.S. and Europe. Adding donor and operative factors to recipient characteristics significantly increased our understanding of 1 year survival of liver grafts.