Introduction Approximately 75% of patients with chronic liver disease have anaemia secondary to iron deficiency, haemorrhage, haemolysis, reduced erythropoiesis, hypersplenism, drugs or haemodilution. In other specialties (cardiac and renal) it has been proven that pre-transplant anaemia impacts negatively on both patient and graft survival. This has not been studied in liver graft recipients.
Aim To define whether pre-transplant Hb levels impact on the 5-year survival and the need for re-transplantation.
Method Retrospective study of all patients who had liver transplantation (LT) at our centre between 1 August 1988 and 1 August 1999. Patients were included if they had a pre-LT haemoglobin (Hb) level recorded and 5-year follow-up available. Hb is expressed in g/dl. In order to define a survival threshold, patients were classified according to their Hb levels (Hb<8, Hb=8–10, Hb=10–12, Hb>12). Statistical analysis was performed using χ2 test, Kaplan–Meier and Student t test.
Results 720 patients were included. Mean age [SEM] was 37 [0.6]. Males were 349/720 (49%). 198 patients had Hb>12 g/dl, 318 had Hb between 10 and 12 g/dl, 182 had Hb 8–10 g/dl and 22 had Hb <8 g/dl. Mean age of each group was 41 [1.1], 37 [1.0], 34 [1.3], 24 [3.2] (p<0.01) respectively. The 5-year survival was 60%, 63%, 50% and 59% respectively (p<0.05). There was no difference between these Hb groups in relation to the need for retransplant. Using a Hb level of 10 g/dl as a cut-off value, a Kaplan–Meier survival analysis (see Abstract P82 figure 1) showed that survival was significantly improved in patients with a pre-LT level of ≥10 g/dl (p<0.01). Simultaneous multi-variate binary logistic regression [OR, (CI), p value] showed that age [0.98, (0.97 to 0.99), <0.01], Hb≥10 [1.6, (1.2 to 2.3), <0.01] and a diagnosis of PBC [2.5, (1.3 to 4.6), <0.01] could predict the 5-year survival post-LT.
Conclusion This study demonstrates a significantly worse 5-year survival in patients with pre-LT Hb<10 g/dl. Prospective randomised trials to study the impact of correction of pre-LT Hb<10 g/dl on the long-term survival is required to define a treatment strategy.