Open AccessVon Willebrand factor and alkaline phosphatase predict re‐transplantation‐free survival after the first liver transplantation
Author(s) -
Wannhoff Andreas,
Rauber Conrad,
Friedrich Kilian,
Rupp Christian,
Stremmel Wolfgang,
Weiss Karl Heinz,
Schemmer Peter,
Gotthardt Daniel N
Publication year - 2017
Publication title -
ueg journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.667
H-Index - 35
eISSN - 2050-6414
pISSN - 2050-6406
DOI - 10.1177/2050640616650060
Subject(s) - medicine , liver transplantation , von willebrand factor , gastroenterology , transplantation , clinical endpoint , alkaline phosphatase , receiver operating characteristic , surgery , platelet , randomized controlled trial , biochemistry , enzyme , chemistry
Background After liver transplantation (LT), there are liver‐related, infectious and cardiovascular complications that contribute to reduced graft survival. These conditions are associated with an increase in the Von Willebrand factor antigen (VWF‐Ag), which was previously correlated with survival in cirrhotic patients. Objective Evaluate VWF‐Ag as a predictive marker of re‐transplantation‐free survival in patients after LT. Methods We measured VWF‐Ag in patients after first LT and then followed them prospectively with regard to the primary endpoint, namely re‐transplantation‐free survival. Results There were 6 out of 80 patients who died or received re‐LT during follow‐up. In these patients, the median VWF‐Ag was 510.6%, which was significantly higher ( p = 0.001) than in the patients who were alive at the end of follow‐up (with a median VWF‐Ag = 186.8%). At a cut‐off of 286.8%, VWF‐Ag was significantly correlated with re‐transplantation‐free survival ( p < 0.001). VWF‐Ag was independently associated with re‐transplantation‐free survival in a multivariate analysis; as was alkaline phosphatase (ALP), but not the model of end‐stage liver disease (MELD) score, donor age, nor cold ischemia time. A score combining VWF‐Ag and ALP showed an impressive capability in the receiver operating characteristic (ROC) analysis (with area under the curve (AUC) = 0.958) to distinguish between patients with regard to the primary endpoint. Conclusions VWF‐Ag is a non‐invasive marker that can predict outcome in patients after LT. Its diagnostic performance increased when combined with ALP in a newly developed scoring system.