P71 A model to improve performance of current category 9 UK listing criteria: early liver graft dysfunction. A single centre cohort: Abstract P71 Table 1

Abstract

Introduction: Current super urgent criteria for listing for early liver graft dysfunction (ELGD) in UK(category 9, C9C) is defined as fulfilling 2 out of 4 criteria within 7 days post liver transplant (LT): AST >10,00IU/l, INR >3, Lactate >3mmol/l and absence of bile production. We demonstrated that these criteria have low sensitivity in predicting early post-LT outcomes( Al-Freah et al. Hepatology 2009;50 Suppl 4:A148). Aim: To develop an improved predictive model for ELGD using early post-LT clinical features. Method: Retrospective study of patients transplanted at our centre 01/01/2000 to 31/12/2008. Daily clinical and laboratory parameters for the first 7 days post LT were reviewed. Results: Over the study period, 1286 patients underwent first LT at our centre. Patients excluded (28) because of re-LT for hepatic artery thrombosis (22), died on table (5) and one re-LT because of donor cancer . We analysed data on 1258 patients (median age 51 (16- 74)years (16-74), 60% male). The most common aetiology was viral hepatitis in 303 patients (24%) and alcohol related liver disease in 227 patients (18%); 181 patients (14.4%) with hepatocellular carcinoma. Median MELD score 16 (6-40). Death or re-LT rate at 3 months was 9.9% (124) Only 27 (2.1%)s fulfilled C9C at 3 months: Seventeen (63%) of those died or had re-LT within 3 months (p<0.001). C9C had sensitivity of 14% (9.8-17%), specificity 99% (98-99%), positive likelihood ratio (LR+) 15.533 (7.41-32.73) and negative likelihood ration (LR-) 0.87 (0.83-0.91). Table 1 shows the univariate and multivariate analyses of predictors of 3 months liver-related death or re-LT using Cox regression hazard method. Accordingly, we generated a model comprises any 1 of the following 5 to predict ELGD and death or re-LT: vasopressors requirement at day D7, D1 lactate >3mmol/l, D7 AST >500IU/l and D7 bilirubin >100(mu)mol/l. Eighty five of 124 patients who had a 3 month liver related outcome met this criterion compared to 16 who met C9C.This gave sensitivity 68% (58-77%), specificity 67% (64-70%), LR+ 2.08 (1.77 to 2.45) and LR- 0.48 (0.36 to 0.63). Conclusion: The new model is simple to use and significantly improved the sensitivity of detection of severe ELGD . Validation in another cohort of LT patients is warranted. (Table Presented).