mortality and its determinants in adult patients with end-stage liver disease on waiting list for liver transplantation: a preliminary report on baseline data

Background: prevention of death in patients on the waiting list for liver transplantation (lt) is a major concern to prioritize organ allocation. since the model for the end-stage liver disease (meld) and its modifications have many shortages, there is a need for further refinement of the allocation strategy. objectives: the current study aimed at assessing the predictors of mortality in lt candidates in a more comprehensive manner with the possible implications to improve the care of such patients and assist in developing better strategies for organ allocation. methods: in the current cohort study, 544 adult lt candidates with end-stage liver disease were followed up for a mean of 12 months in three-month intervals. data analysis was performed in nutritionist, spss, and r software, using kaplan-meier, cox proportional hazard (hrc), and lasso cox regression hazard (hrl) tests. results: the mean age of the patients was 46.7  13.7 years; the majority were male (n = 336, 61.7%). at the end of the study, 414 (76.1%) subjects were still alive and 130 (23.9%) dead. the cumulative percentages of death were 33.1%, 57.7%, and 79.2% after 3, 6, and 12 months of waiting for a donor, respectively. although there was a strong association between having hepatopulmonary syndrome (hps) (hrc = 4.7, hrl = 1.8), a history of myocardial infarction (mi) (hrc = 3.3, hrl = 1.6), low-carbohydrate (cho) diet (hrc = 2.7, hrl = 1.5), and mortality, it was weak for meld score. moreover, a serum level of ca 125, high polymorphonuclear (pmn) count, weight loss, a high level of alanine aminotransferase (alt), positive hepatitis b virus (hbv) markers, high mean corpuscular volume (mcv) of red blood cells, ascites, and edema of gallbladder wall had association with mortality in lt patients. conclusions: in addition to meld score, hps, a history of mi, low cho intake, weight loss, ascites, pmn, ca 125, alt, hepatitis b surface antigen, mcv, blood urea nitrogen, and gallbladder wall thickness are predictors of mortality in lt candidates and need to be considered in the lt allocation system.