The effects of prognostic factors on transplant and mortality of patients with end-stage liver disease using Markov multistate model

Background: Decompensated cirrhosis patients have a high risk of death which can be considerably reduced with liver transplantation (LT). This study aimed to simultaneously investigate the effect of some patients' characteristics on mortality among those with/without LT and also LT incident.Materials and Methods: In this historical cohort study, the information from 780 eligible patients aged 18 years or older was analyzed by the Markov multistate model; they had been listed between 2008 and 2014, needed a single organ for initial orthotopic LT, and followed at least for up to 5 years.Results: With a median survival time of 6 (5-8) years, there were 275 (35%) deaths. From 255 (33%) patients who had LT, 55 (21%) subsequently died. Factors associated with a higher risk of mortality and LT occurrence were included: higher model for end-stage liver disease (MELD) score (hazard ratio [HR] = 1.16, confidence interval [CI]: 1.09-1.24 and HR = 1.22, CI: 1.41-1.30) and ascites complication (HR = 2.34, CI: 1.74-3.16 and HR = 11.43, CI: 8.64-15.12). Older age (HR = 1.03, CI: 1.01-1.06), higher creatinine (HR = 6.87, CI: 1.45-32.56), and autoimmune disease versus hepatitis (HR = 2.53, CI: 1.12-5.73) were associated with increased risk of mortality after LT.Conclusion: The MELD and ascites are influential factors on waiting list mortality and occurrence of LT. Total life expectancy is not influenced by higher MELD.