Abstract | BACKGROUND & AIMS: METHODS: We performed a retrospective cohort study using data submitted to the United Network for Organ Sharing in a study of the effects of room-air oxygenation on pre- and post- transplantation outcomes of patients with HPS. We identified thresholds associated with post- transplantation survival using cubic spline analysis and compared overall survival times of patients with and without HPS. RESULTS: From 2002 through 2012, nine hundred and seventy-three patients on the liver transplant waitlist received HPS exception points. There was no association between oxygenation and waitlist mortality among patients with HPS exception points. Transplant recipients with more severe hypoxemia had increased risk of death after liver transplantation. Rates of 3-year unadjusted post- transplantation survival were 84% for patients with PaO2 of 44.1-54.0 mm Hg vs 68% for those with PaO2 ≤ 44.0 mm Hg. In multivariable Cox models, transplant recipients with an initial room-air PaO2 ≤ 44.0 mm Hg had significant increases in post- transplantation mortality (hazard ratio = 1.58; 95% confidence interval [CI]: 1.15-2.18) compared with those with a PaO2 of 44.1-54.0 mm Hg. Overall mortality was significantly lower among waitlist candidates with HPS exception points than those without (hazard ratio = 0.82; 95% CI: 0.70-0.96), possibly because patients with HPS have a reduced risk of pre- transplantation mortality and similar rate of post- transplantation survival. CONCLUSIONS:
|
Authors | David S Goldberg, Karen Krok, Sachin Batra, James F Trotter, Steven M Kawut, Michael B Fallon |
Journal | Gastroenterology
(Gastroenterology)
Vol. 146
Issue 5
Pg. 1256-65.e1
(May 2014)
ISSN: 1528-0012 [Electronic] United States |
PMID | 24412528
(Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, U.S. Gov't, P.H.S., Webcast)
|
Copyright | Copyright © 2014 AGA Institute. Published by Elsevier Inc. All rights reserved. |
Topics |
- Databases, Factual
- Female
- Hepatopulmonary Syndrome
(complications, diagnosis, mortality, therapy)
- Humans
- Hypoxia
(etiology, mortality)
- Liver Transplantation
(adverse effects, mortality)
- Male
- Middle Aged
- Oxygen Inhalation Therapy
- Patient Selection
- Proportional Hazards Models
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Time Factors
- Tissue and Organ Procurement
- Treatment Outcome
- United States
- Waiting Lists
(mortality)
|