Physiology and health assessment, risk balance, and model for end-stage liver disease scores: Postoperative outcome of liver transplantation.

Abstract

Background: Liver transplantation aims to increase the survival of patients with end-stage liver diseases and improve their quality of life. The number of organs available for transplantation is lower than the demand. To provide fair organ distribution, predictive mortality scores have been developed.

Aim: To compare the Acute Physiology and Chronic Health Evaluation IV (APACHE IV), balance of risk (BAR), and model for end-stage liver disease (MELD) scores as predictors of mortality.

Methods: Retrospective cohort study, which included 283 adult patients in the postoperative period of deceased donor liver transplantation from 2014 to 2018.

Results: The transplant recipients were mainly male, with a mean age of 58.1 years. Donors were mostly male, with a mean age of 41.6 years. The median cold ischemia time was 3.1 hours, and the median intensive care unit stay was 5 days. For APACHE IV, a mean of 59.6 was found, BAR 10.7, and MELD 24.2. The 28-day mortality rate was 9.5%, and at 90 days, it was 3.5%. The 28-day mortality prediction for APACHE IV was very good [area under the curve (AUC): 0.85, P < 0.001, 95%CI: 0.76-0.94], P < 0.001, BAR (AUC: 0.70, P < 0.001, 95%CI: 0.58-0.81), and MELD (AUC: 0.66, P < 0.006, 95%CI: 0.55-0.78), P < 0.008. At 90 days, the data for APACHE IV were very good (AUC: 0.80, P < 0.001, 95%CI: 0.71-0.90) and moderate for BAR and MELD, respectively, (AUC: 0.66, P < 0.004, 95%CI: 0.55-0.77), (AUC: 0.62, P < 0.026, 95%CI: 0.51-0.72). All showed good discrimination between deaths and survivors. As for the best value for liver transplantation, it was significant only for APACHE IV (P < 0.001).

Conclusion: The APACHE IV assessment score was more accurate than BAR and MELD in predicting mortality in deceased donor liver transplant recipients.