The APACHE III score as preoperative indicator of patient outcome in liver transplantation after fulminant hepatic failure
Panagiotis Fikatas, Frank Ulrich, Ji-Eun Lee, Igor M. Sauer, Sascha Chopra, Sven C. Schmidt, Andreas Pascher, Johann Pratschke
Ann Transplant 2011; 16(1): 18-25
Background: Given the current organ shortage, an accurate assessment of the patient’s outcome after orthotopic liver transplantation (OLTX) for fulminant hepatic failure (FHF) is crucial in order to determine the suitability for transplantation. The purpose of this study was to assess whether APACHE II and III scores would provide prognosis of posttransplant mortality.
Material/Methods: The study included 129 patients with FHF who underwent OLTX between 1988 and 2008. APACHE II and III scores were calculated one day before transplantation and correlated with postoperative mortality. The cohort consisted of 42 males and 87 females with a mean age of 32±17 years.
Results: Gender, age and etiology of FHF did not correlate with posttransplant survival (p=NS). The APACHE II score was not significantly higher amongst 30-day non-survivors (p=NS). Both patients who died during this period had a significantly higher APACHE III score compared to survivors (82±19.4 vs. 62±18, p<0.01). Patients with an APACHE III score >68 had a significantly higher mortality rate (p<0.01). Cox regression analysis revealed the APACHE III score as a significant predictor of death (p<0.001). Each additional point in the APACHE III system raises the postoperative mortality by 3.1%.
Conclusions: The major advantage of the APACHE III score is that its application and prognostic ability is independent from etiology of FHF. This accurate and reproducible evaluation system could be useful to identify patients with poor outcome.
Keywords: acute liver failure, Mortality, prognosis