19 September 2008
Mayo risk score for primary biliary cirrhosis: A useful tool for the prediction of course after liver transplantation?Dietmar A. Jacob, Marcus Bahra, Sven C. Schmidt, Guido Schumacher, Andreas Weimann, Peter Neuhaus, Ulf P. Neumann
Ann Transplant 2008; 13(3): 35-42 :: ID: 868537
Background: Survival after orthotopic liver transplantation (OLT) for primary biliary cirrhosis (PBC) is excellent. In order to define the optimal time point for OLT, the Mayo risk score (MRS) was developed and a score of 7.8 was identified for transplantation. However, in reality most recipients are in a bad condition with a MRS above 7.8. So far it is still unknown if a higher score is associated with more complications after OLT perioperatively and in a long-term follow-up. Therefore, this study was designed to investigate the association of the MRS score with postoperative survival and complications.
Material/Methods: Between 1989 and 2006, 115 patients were transplanted for histologically proven PBC at the Charité Campus Virchow Clinic. In 98 of these patients, MRS data was available and retrospectively analyzed. Median age of 87 women and 11 men was 54 years (25 to 66 years).
Results: The median follow-up after liver transplantation was 109 months (0.5–205 months). Actuarial patient survival after 5, 10 and 15 years was 90%, 88%, and 83%. Calculated survival by MRS without transplantation after 1, 5 and 7 years was 20%, 2% and 1% for these patients. Twelve patients (12%) died and histological recurrence of PBC was detected in 14 patients (14%). Seven patients underwent retransplantation (7%) and 58 patients developed an acute rejection episode (59%). Mean MRS was in all patients 9.54±1.35 and did not differ between patients with lethal course, retransplantations, PBC recurrence, rejection episodes and duration of hospital stay. Classification of all patients into a low (<8.5), middle (8.5–10) and high MRS score (>10) did not show a significant difference in long-term survival. Univariate analysis for identifying the level of MRS as risk for death, PBC-recurrence, retransplantation, acute rejection episodes and hospital stay only showed a significant increased risk for acute rejection episodes (1 episode = 0.04; 2 episodes = 0.01) for patients with a MRS above 8.5.
Conclusions: The Mayo risk score is an approved mathematical model predicting survival in non-transplanted patients suffering from PBC. However, the score did not predict the course of our liver transplanted patients in a long-term follow-up. We could not demonstrate a reduced patient survival at a median MRS of 9.4 and about 10.0. Therefore, it is, from our point of view, questionable if the optimal time point for OLT is still 7.8.
Keywords: Liver Transplantation, mayo risk score, Survival
20 Jan 2022 : Original articleImpact on Waitlist Outcomes from Changes in the Medical Eligibility of Candidates for Simultaneous Liver-Ki...
Ann Transplant In Press; DOI: 10.12659/AOT.934850
19 Jan 2022 : Original articleCarbohydrate Metabolism Disorders in Relation to Cardiac Allograft Vasculopathy (CAV) Intensification in He...
Ann Transplant In Press; DOI: 10.12659/AOT.933420
18 Jan 2022 : Original articlePLGA+Fe₃O₄+PFP Nanoparticles Drug-Delivery Demonstrates Potential Anti-Tumor Effects on Tumor Cells
Ann Transplant In Press; DOI: 10.12659/AOT.933246
Most Viewed Current Articles
29 Dec 2021 : Original articleEfficacy and Safety of Tacrolimus-Based Maintenance Regimens in De Novo Kidney Transplant Recipients: A Sys...
Ann Transplant 2021; 26:e933588
22 Dec 2021 : Original articleComparison of Coronary Artery Calcium Scoring with Dobutamine Stress Echo for Detection of Coronary Artery ...
Ann Transplant 2021; 26:e934163
12 Jan 2022 : Original articleRisk Factors for Developing BK Virus-Associated Nephropathy: A Single-Center Retrospective Cohort Study of ...
Ann Transplant 2022; 27:e934738