Prediction of the prognosis after liver transplantation in severe hepatitis B–induced liver failure and clinical decision for liver transplantation

BackgroundSevere hepatitis B–induced liver failure (SHBLF) patients who require liver transplantation represent a particular challenge. We sought to explore the prognostic factors and establish a new scoring model, the SHBLF prognosis model (SHBLFPM), which can aid in clinical decision making.Materials and methodsA total of 98 patients who underwent liver transplantation for SHBLF in our center were retrospectively recruited between January 1, 1999, and December 31, 2010. The clinical and biochemical data were analyzed using the Cox proportional hazards model and log-rank test. The receiver operating characteristic curves were obtained for the King's College Hospital (KCH) criterion, the model for end-stage liver disease (MELD), and the new model; the areas under the curves were compared using a z-test.ResultsThe independent factors predicting the prognosis were the age of the patient (AP, P = 0.017), hepatic encephalopathy (HE, P = 0.013), the serum total bilirubin concentration (TBiL, P < 0.001), and the international normalized ratio for prothrombin time (INR, P = 0.001), as identified using a multivariate Cox regression analysis. The area under the curve of the new regression model (0.881) was significantly larger than that of the MELD (0.783) and KCH scores (0.596) (P < 0.05). Patients with a preoperative SHBLFPM score <23.57 had a significantly better prognosis than those with higher scores (P < 0.001).ConclusionsAge of patient, hepatic encephalopathy, serum total bilirubin concentration, and international normalized ratio for prothrombin time are independent factors affecting the posttransplantation mortality of SHBLF patients. SHBLFPM may be a criterion for the clinical decision for liver transplantation in SHBLF patients with a greater prognostic predictive ability than the MELD and KCH models.