Timing of transplantation for primary biliary cirrhosis

✍ Scribed by Piotr Krzeski; Adrzej Habior

• Publisher: John Wiley and Sons
• Year: 1999
• Tongue: English
• Weight: 30 KB
• Volume: 29
• Category: Article
• ISSN: 0270-9139
• DOI: 10.1002/hep.510290207

✦ Synopsis

Kim et al. described

in the July issue of HEPATOLOGY the application of the Mayo Clinic survival model for optimal timing of liver transplantation in patients with primary biliary cirrhosis. 1 I would like to note that their application of the model for follow-up data, although widely used, is formally improper. The same opinion was presented by Neuberger in European Journal of Gastroenterology and Hepatology. 2 The original Mayo Clinic survival model was based on data from a single time point of randomization to a clinical trial. 3 The average risk index for the 418 patients on whom the model was developed was 5.07. The average risk index for patients undergoing orthotropic liver transplantation in Dr. Kim' s series was 7.5, a value that, according to the original Mayo Clinic model, leads to an estimated 1-and 2-year survival probability of 70% and 50%, respectively. For patients with such a high risk of death, the estimated survival has wide confidence limits and tends to be overestimated. 4 For this reason the same group of investigators developed an updated model based on repeated patient visits. 5 The use of the updated model for optimal timing of OLT would have been formally justified for follow-up data and would have given more accurate predicted survival estimation. Although the prediction of survival with the updated model can only be made for 2 years in advance, it is this time from OLT that accounted for about 80% of deaths in the series studied by Kim et al.

I have every reason to believe that the application of the original Mayo Clinic survival model for the primary biliary cirrhosis patients undergoing OLT overestimates the survival benefit and that the accuracy of the estimated survival can be improved using the updated model.