Confirmation of the Role of the Mayo Risk Score as a
Predictor of Resource Utilization After Orthotopic Liver
Transplantation for Primary Biliary Cirrhosis
Richard K. Gilroy, Stephen V. Lynch, Russell W. Strong, Paul Kerlin,
Glenda A. Balderson, Katherine A. Stuart, and Darrell H.G. Crawford
Resource utilization is an important consideration when
patients are selected for orthotopic liver transplantation
(OLT). The Mayo Risk Score has been proposed to help
predict optimum time for OLT. We assessed the relation
between Mayo risk score, Child-Pugh score, and resource
utilization and outcome after OLT for primary biliary
cirrhosis. The mean Mayo risk score was greater in pa-
tients who died than in the survivors (8.6 ؎ 1.4 v 7.1 ؎
1.8; P < .05). There was a positive correlation between
Mayo risk score and the 4 resource variables studied
(intraoperative blood requirements, time ventilated, and
duration of intensive care unit and hospital stays). Pa-
tients with a Mayo risk score greater than 7.8 used almost
twice the resources of patients with a risk score less than
7.8. A positive correlation also existed between Child-
Pugh score and duration of hospital stay. The mean
Child-Pugh score in patients who died was greater than
that in survivors (10.7 ؎ 2.0 v 8.5 ؎ 2.8, P ؍
.03). This
study confirms that Mayo Risk score is an important pre-
dictor of resource utilization and outcome after OLT.
(Liver Transpl 2000;6:749-752.)
liver transplant units for factors affecting resource uti-
lization. These factors include patient selection, surgical
technique, method of immunosuppression, manage-
ment of rejection episodes, approach to posttransplan-
tation infectious complications, and clinical experience.
Thus, it is important that other liver transplant centers,
particularly those outside the United States, also evalu-
ate the predictive value of the Mayo risk score to con-
firm whether the model has widespread application
with respect to outcome and resource utilization after
OLT.
Assessment of Mayo risk score is relatively difficult
in a clinical setting despite the development of comput-
erized methods of calculation. Child-Pugh score, a
commonly used marker of liver disease severity, con-
tains many of the criteria used in the Mayo model.5
Therefore, the Child-Pugh score, which is easier to cal-
culate than the Mayo risk score, may also be useful in
predicting resource utilization after OLT for PBC.
In this study, we evaluated the relation between the
Mayo risk score, Child-Pugh score, and resource utili-
zation after OLT in a cohort of patients with PBC from
an Australian liver transplant center.
rimary biliary cirrhosis (PBC), a slowly progressive
P
inflammatory disease of septal and interlobular bile
ducts, is a common indication for orthotopic liver
transplantation (OLT).1,2 The shortage of donor or-
gans and the need for judicious decisions in the selec-
tion and timing for OLT mandate that OLT be per-
formed at a time that optimizes patient outcome and
ensures the appropriate use of limited medical re-
sources.
Patients and Methods
The Queensland Liver Transplant Service (Brisbane, Austra-
lia) assessed 60 patients with PBC for OLT between July 1986
and December 1998. Of these 60 patients, 48 patients were
accepted onto the active waiting list and 5 patients died before
OLT. Thus, 43 patients underwent OLT during the study
period.
The Mayo PBC natural history model3 allows the
calculation of a risk score using 5 variables (patient age,
total serum bilirubin and albumin concentrations, pro-
thrombin time, and presence of peripheral edema). The
Mayo risk score can then be used to estimate patient
survival. Recently, Kim et al4 reported that the Mayo
risk score might also have an important role in deciding
optimal timing for OLT. Their data showed that the
risk for death after OLT acutely increased with a Mayo
risk score greater than 7.8. Similarly, resource utiliza-
tion, measured by days in the intensive care unit and
number of intraoperative blood transfusions, was
greater in the group of transplant recipients with a
Mayo risk score greater than 7.8 at the time of OLT.
Significant diversity often exists among different
At the time of acceptance onto the transplant program,
From the Queensland Liver Transplant Service, Princess Alexandra
Hospital, Brisbane, Australia.
Address reprint requests to Darrell H.G. Crawford, MD, Director,
Department of Gastroenterology and Hepatology, Princess Alexandra
Hospital, Ipswich Rd, Woolloongabba 4102, Queensland, Australia.
Telephone: 61-7-3240-2613; FAX: 61-7-3240-5111; E-mail:
©
Copyright 2000 by the American Association for the Study of
Liver Diseases
1527-6465/00/0606-0101$3.00/0
doi:10.1053/jlts.2000.9746
Liver Transplantation, Vol 6, No 6 (November), 2000: pp 749-752
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