Predictors of Waitlist Mortality in Portopulmonary Hypertension

Hilary M. Dubrock, David S. Goldberg, Norman L. Sussman, Sonja D. Bartolome, Zakiyah Kadry, Reena J. Salgia, David C. Mulligan, Walter K. Kremers, Steven M. Kawut, Michael J. Krowka, Richard N. Channick

Research output: Contribution to journalArticle

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Abstract

Background The current Organ Procurement Transplantation Network policy grants Model for End-Stage Liver Disease (MELD) exception points to patients with portopulmonary hypertension (POPH), but potentially important factors, such as severity of liver disease and pulmonary hypertension, are not included in the exception score, and may affect survival. The purpose of this study was to identify significant predictors of waitlist mortality in patients with POPH. Methods We performed a retrospective cohort study of patients in the Organ Procurement and Transplantation Network database with hemodynamics consistent with POPH (defined as mean pulmonary arterial pressure >25 mm Hg and pulmonary vascular resistance [PVR] ≥240 dynes·s·cm -5) who were approved for a POPH MELD exception between 2006 and 2014. Using a Cox proportional hazards model, we identified predictors of waitlist mortality (or removal for clinical deterioration). Results One hundred ninety adults were included. Age (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.00-1.08; P = 0.0499), initial native MELD score (HR, 1.11; 95% CI, 1.05-1.17; P < 0.001), and initial PVR (HR, 1.12 per 100 dynes·s·cm -5; 95% CI, 1.02-1.23; P = 0.02) were the only significant univariate predictors of waitlist mortality and remained significant predictors in a multivariate model, which had a c-statistic of 0.71. PVR and mean pulmonary arterial pressure were not significant predictors of posttransplant mortality. Conclusions Both the severity of liver disease and POPH (as assessed by MELD and PVR, respectively) were significantly associated with waitlist, but not posttransplant, mortality in patients with approved MELD exceptions for POPH. Both factors should potentially be included in the POPH MELD exception score to more accurately reflect waitlist mortality risk.

Original languageEnglish (US)
Pages (from-to)1609-1615
Number of pages7
JournalTransplantation
Volume101
Issue number7
DOIs
StatePublished - Jul 1 2017

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End Stage Liver Disease
Hypertension
Mortality
Vascular Resistance
Tissue and Organ Procurement
Organ Transplantation
Confidence Intervals
Liver Diseases
Arterial Pressure
Lung
Organized Financing
Proportional Hazards Models
Pulmonary Hypertension
Cohort Studies
Retrospective Studies
Hemodynamics
Databases
Survival

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Dubrock, H. M., Goldberg, D. S., Sussman, N. L., Bartolome, S. D., Kadry, Z., Salgia, R. J., ... Channick, R. N. (2017). Predictors of Waitlist Mortality in Portopulmonary Hypertension. Transplantation, 101(7), 1609-1615. https://doi.org/10.1097/TP.0000000000001666
Dubrock, Hilary M. ; Goldberg, David S. ; Sussman, Norman L. ; Bartolome, Sonja D. ; Kadry, Zakiyah ; Salgia, Reena J. ; Mulligan, David C. ; Kremers, Walter K. ; Kawut, Steven M. ; Krowka, Michael J. ; Channick, Richard N. / Predictors of Waitlist Mortality in Portopulmonary Hypertension. In: Transplantation. 2017 ; Vol. 101, No. 7. pp. 1609-1615.
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abstract = "Background The current Organ Procurement Transplantation Network policy grants Model for End-Stage Liver Disease (MELD) exception points to patients with portopulmonary hypertension (POPH), but potentially important factors, such as severity of liver disease and pulmonary hypertension, are not included in the exception score, and may affect survival. The purpose of this study was to identify significant predictors of waitlist mortality in patients with POPH. Methods We performed a retrospective cohort study of patients in the Organ Procurement and Transplantation Network database with hemodynamics consistent with POPH (defined as mean pulmonary arterial pressure >25 mm Hg and pulmonary vascular resistance [PVR] ≥240 dynes·s·cm -5) who were approved for a POPH MELD exception between 2006 and 2014. Using a Cox proportional hazards model, we identified predictors of waitlist mortality (or removal for clinical deterioration). Results One hundred ninety adults were included. Age (hazard ratio [HR], 1.04; 95{\%} confidence interval [CI], 1.00-1.08; P = 0.0499), initial native MELD score (HR, 1.11; 95{\%} CI, 1.05-1.17; P < 0.001), and initial PVR (HR, 1.12 per 100 dynes·s·cm -5; 95{\%} CI, 1.02-1.23; P = 0.02) were the only significant univariate predictors of waitlist mortality and remained significant predictors in a multivariate model, which had a c-statistic of 0.71. PVR and mean pulmonary arterial pressure were not significant predictors of posttransplant mortality. Conclusions Both the severity of liver disease and POPH (as assessed by MELD and PVR, respectively) were significantly associated with waitlist, but not posttransplant, mortality in patients with approved MELD exceptions for POPH. Both factors should potentially be included in the POPH MELD exception score to more accurately reflect waitlist mortality risk.",
author = "Dubrock, {Hilary M.} and Goldberg, {David S.} and Sussman, {Norman L.} and Bartolome, {Sonja D.} and Zakiyah Kadry and Salgia, {Reena J.} and Mulligan, {David C.} and Kremers, {Walter K.} and Kawut, {Steven M.} and Krowka, {Michael J.} and Channick, {Richard N.}",
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Dubrock, HM, Goldberg, DS, Sussman, NL, Bartolome, SD, Kadry, Z, Salgia, RJ, Mulligan, DC, Kremers, WK, Kawut, SM, Krowka, MJ & Channick, RN 2017, 'Predictors of Waitlist Mortality in Portopulmonary Hypertension', Transplantation, vol. 101, no. 7, pp. 1609-1615. https://doi.org/10.1097/TP.0000000000001666

Predictors of Waitlist Mortality in Portopulmonary Hypertension. / Dubrock, Hilary M.; Goldberg, David S.; Sussman, Norman L.; Bartolome, Sonja D.; Kadry, Zakiyah; Salgia, Reena J.; Mulligan, David C.; Kremers, Walter K.; Kawut, Steven M.; Krowka, Michael J.; Channick, Richard N.

In: Transplantation, Vol. 101, No. 7, 01.07.2017, p. 1609-1615.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Predictors of Waitlist Mortality in Portopulmonary Hypertension

AU - Dubrock, Hilary M.

AU - Goldberg, David S.

AU - Sussman, Norman L.

AU - Bartolome, Sonja D.

AU - Kadry, Zakiyah

AU - Salgia, Reena J.

AU - Mulligan, David C.

AU - Kremers, Walter K.

AU - Kawut, Steven M.

AU - Krowka, Michael J.

AU - Channick, Richard N.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - Background The current Organ Procurement Transplantation Network policy grants Model for End-Stage Liver Disease (MELD) exception points to patients with portopulmonary hypertension (POPH), but potentially important factors, such as severity of liver disease and pulmonary hypertension, are not included in the exception score, and may affect survival. The purpose of this study was to identify significant predictors of waitlist mortality in patients with POPH. Methods We performed a retrospective cohort study of patients in the Organ Procurement and Transplantation Network database with hemodynamics consistent with POPH (defined as mean pulmonary arterial pressure >25 mm Hg and pulmonary vascular resistance [PVR] ≥240 dynes·s·cm -5) who were approved for a POPH MELD exception between 2006 and 2014. Using a Cox proportional hazards model, we identified predictors of waitlist mortality (or removal for clinical deterioration). Results One hundred ninety adults were included. Age (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.00-1.08; P = 0.0499), initial native MELD score (HR, 1.11; 95% CI, 1.05-1.17; P < 0.001), and initial PVR (HR, 1.12 per 100 dynes·s·cm -5; 95% CI, 1.02-1.23; P = 0.02) were the only significant univariate predictors of waitlist mortality and remained significant predictors in a multivariate model, which had a c-statistic of 0.71. PVR and mean pulmonary arterial pressure were not significant predictors of posttransplant mortality. Conclusions Both the severity of liver disease and POPH (as assessed by MELD and PVR, respectively) were significantly associated with waitlist, but not posttransplant, mortality in patients with approved MELD exceptions for POPH. Both factors should potentially be included in the POPH MELD exception score to more accurately reflect waitlist mortality risk.

AB - Background The current Organ Procurement Transplantation Network policy grants Model for End-Stage Liver Disease (MELD) exception points to patients with portopulmonary hypertension (POPH), but potentially important factors, such as severity of liver disease and pulmonary hypertension, are not included in the exception score, and may affect survival. The purpose of this study was to identify significant predictors of waitlist mortality in patients with POPH. Methods We performed a retrospective cohort study of patients in the Organ Procurement and Transplantation Network database with hemodynamics consistent with POPH (defined as mean pulmonary arterial pressure >25 mm Hg and pulmonary vascular resistance [PVR] ≥240 dynes·s·cm -5) who were approved for a POPH MELD exception between 2006 and 2014. Using a Cox proportional hazards model, we identified predictors of waitlist mortality (or removal for clinical deterioration). Results One hundred ninety adults were included. Age (hazard ratio [HR], 1.04; 95% confidence interval [CI], 1.00-1.08; P = 0.0499), initial native MELD score (HR, 1.11; 95% CI, 1.05-1.17; P < 0.001), and initial PVR (HR, 1.12 per 100 dynes·s·cm -5; 95% CI, 1.02-1.23; P = 0.02) were the only significant univariate predictors of waitlist mortality and remained significant predictors in a multivariate model, which had a c-statistic of 0.71. PVR and mean pulmonary arterial pressure were not significant predictors of posttransplant mortality. Conclusions Both the severity of liver disease and POPH (as assessed by MELD and PVR, respectively) were significantly associated with waitlist, but not posttransplant, mortality in patients with approved MELD exceptions for POPH. Both factors should potentially be included in the POPH MELD exception score to more accurately reflect waitlist mortality risk.

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Dubrock HM, Goldberg DS, Sussman NL, Bartolome SD, Kadry Z, Salgia RJ et al. Predictors of Waitlist Mortality in Portopulmonary Hypertension. Transplantation. 2017 Jul 1;101(7):1609-1615. https://doi.org/10.1097/TP.0000000000001666