I read with great interest and congratulate Sierra et al. on their study [1] entitled “Influence of socioeconomic factors on liver transplant survival outcomes in patients with autoimmune liver disease in the United States.” The authors revealed that the lack of college education, public insurance and not working for income have detrimental impact on post-liver transplant (LT) survival outcomes.
Apart from the wide array of covariates included in the study data by Sierra et al., there are additional factors that can predict post-LT outcomes. Older age, high neutrophil-to-lymphocyte ratio and poor psychosocial status (depression, anxiety, ineffective coping strategies and lack of social support) are predictors of unfavorable post-LT outcomes [2,3,4]. Acute-on-chronic liver failure is an independent predictor of one year post-LT survival [5]. Determination of intraoperative splanchnic hypoperfusion by means of gastric tonometry has been shown to be linked to poor graft function [6]. A recently published and striking paper by Huang et al. revealed valuable data backing up the study by Sierra et al., with results showing racial, ethnic and socioeconomic disparities influence post-LT survival in patients with hepatocellular carcinoma [7]. Fatty liver disease, a rising public health problem worldwide, was not found to have a negative impact on LT outcome [8].
Several scoring systems have been proposed over the years for predicting post-LT outcomes. The Balance of Risk (BAR) score and a simple scoring model utilizing aspartate-aminotransferase and alanine-aminotransferase levels were found to be predictors of graft survival and mortality [9,10]. A study by Costabeber et al. revealed D-MELD score was unable to predict survival in LT patients [11]. Finally, there are studies showing that liver transplantations from donors after circulatory death have similar post-LT outcomes compared to those from donors after brain death [12,13].
In conclusion, the article by Sierra et al. contributes greatly to an important topic. Revealing predictors of poor post-LT outcomes is crucial to determining potentially amendable points in the management of the indispensable, multifaceted therapeutic option that is liver transplantation.
