The association of pretransplant ferritin level with waiting list and post-transplant survival. Does ferritin actually predict outcome?

TY - JOUR

T1 - The association of pretransplant ferritin level with waiting list and post-transplant survival. Does ferritin actually predict outcome?

AU - Al-Freah, Mohammad A. B.

AU - Kriese, Stephen

AU - Foxton, Matthew R.

AU - Quaglia, Alberto

AU - Bomford, Adrian

AU - Heaton, Nigel D.

AU - O'Grady, John G.

AU - Agarwal, Kosh

AU - Wendon, Julia A.

AU - Heneghan, Michael A.

PY - 2013/11

Y1 - 2013/11

N2 - Recent data suggest an association of serum ferritin (SF) with waiting list (WL) and postliver transplant (LT) outcomes. To assess the predictive capacity of SF on pre- and post-LT outcomes, and to identify whether recipient or donor liver siderosis is associated with post-LT survival; a retrospective analysis of 1079 patients assessed for first LT, 2000–2007 was performed. Iron deposition in the liver tissue was assessed using a semi-quantitative grading system. Median age was 54 (18–82) years and 67% were male. Seventeen per cent had hepatocellular carcinoma (HCC). Median Model for End-stage Liver Disease MELD score was 14 (6–40), ferritin was 174 μg/l (4–4597) with 36.5% had a SF ≥ μg/l. Age (OR = 1.028) and MELD score (OR = 1.158) were independently associated with WL mortality (P < 0.001), whilst SF was not (P = NS). Age (OR = 1.018), HCC (OR = 1.542) and cold ischemia time (CIT) ≥ 10 h (OR = 1.418) were independently associated with post-LT survival (P < 0.05). Explant siderosis grade <2 was seen in 376 (71.7%) patients. Patients with explant siderosis grade ≥2 had inferior 12-month post-LT survival (P = 0.030). Presence of graft siderosis (15.8% of patients) was not associated with survival. In conclusion, we found a limited role for SF as a prognostic indicator for pre- or post-transplant survival.

AB - Recent data suggest an association of serum ferritin (SF) with waiting list (WL) and postliver transplant (LT) outcomes. To assess the predictive capacity of SF on pre- and post-LT outcomes, and to identify whether recipient or donor liver siderosis is associated with post-LT survival; a retrospective analysis of 1079 patients assessed for first LT, 2000–2007 was performed. Iron deposition in the liver tissue was assessed using a semi-quantitative grading system. Median age was 54 (18–82) years and 67% were male. Seventeen per cent had hepatocellular carcinoma (HCC). Median Model for End-stage Liver Disease MELD score was 14 (6–40), ferritin was 174 μg/l (4–4597) with 36.5% had a SF ≥ μg/l. Age (OR = 1.028) and MELD score (OR = 1.158) were independently associated with WL mortality (P < 0.001), whilst SF was not (P = NS). Age (OR = 1.018), HCC (OR = 1.542) and cold ischemia time (CIT) ≥ 10 h (OR = 1.418) were independently associated with post-LT survival (P < 0.05). Explant siderosis grade <2 was seen in 376 (71.7%) patients. Patients with explant siderosis grade ≥2 had inferior 12-month post-LT survival (P = 0.030). Presence of graft siderosis (15.8% of patients) was not associated with survival. In conclusion, we found a limited role for SF as a prognostic indicator for pre- or post-transplant survival.

KW - hepatic

KW - iron

KW - mortality

KW - transplantation

KW - STAGE LIVER-DISEASE

KW - SERUM FERRITIN

KW - HEPATITIS-C

KW - TRANSPLANTATION SURVIVAL

KW - TRANSFERRIN SATURATION

KW - NATURAL-HISTORY

KW - IRON OVERLOAD

KW - HFE MUTATIONS

KW - MELD SCORE

KW - MODEL

U2 - 10.1111/tri.12164

DO - 10.1111/tri.12164

M3 - Article

SN - 0934-0874

VL - 26

SP - 1070

EP - 1079

JO - Transplant International

JF - Transplant International

IS - 11

ER -