July 2021 - Georg Györi

Priv. Doz. Dr. Georg Györi

MedUni Wien RESEARCHER OF THE MONTH July 2021

The Von Willebrand factor facilitates MELD‐independent risk stratification on the waiting list for liver transplantation (1)

WF-Ag at time of listing was assessed in patients listed for OLT. Clinical characteristics, MELD-Na, and mortality on the waiting list were recorded. Prediction of 3-month waiting-list survival was assessed by receiver operating characteristics and net reclassification improvement. Patients dying within 3 months on the waiting list displayed elevated levels of vWF-Ag (P < 0.001). MELD-Na and vWF-Ag were comparable and independent in their predictive potential for 3-month mortality on the waiting list (area under the curve [AUC], vWF-Ag = 0.739; MELD-Na = 0.764). Importantly, a vWF-Ag cutoff at 413% identified patients at risk for death within 3 months of listing with a higher odds ratio (OR) than the previously published cutoff at a MELD-Na of 20 points (vWF-Ag, OR = 10.873, 95% confidence interval [CI], 3.160, 36.084; MELD-Na, OR = 7.594, 95% CI, 2.578, 22.372; P < 0.001, respectively). Ultimately, inclusion of vWF-Ag into the MELD-Na equation significantly improved prediction of 3-month waiting-list mortality (AUC, MELD-Na–vWF = 0.804). A single measurement of vWF-Ag at listing for OLT predicts early mortality. Combining vWF-Ag levels with MELD-Na improves risk stratification and may help to prioritize organ allocation to decrease waiting-list mortality.

Selected Literature

1. Gyori GP, Pereyra D, Rumpf B, Hackl H, Koditz C, Ortmayr G, Reiberger T, et al. The von Willebrand Factor Facilitates Model for End-Stage Liver Disease-Independent Risk Stratification on the Waiting List for Liver Transplantation. Hepatology 2020;72:584-594.
2. Gyori GP, Schwarzer R, Puspok A, Schofl R, Silberhumer GR, Langer FB, Trauner M, et al. Endoscopic versus surgical management of biliary complications - Outcome analysis after 1188 orthotopic liver transplantations. Dig Liver Dis 2016;48:1323-1329.
3. Schlegel A, Linecker M, Kron P, Gyori G, De Oliveira ML, Mullhaupt B, Clavien PA, et al. Risk Assessment in High- and Low-MELD Liver Transplantation. Am J Transplant 2017;17:1050-1063.
4. Ferlitsch M, Reiberger T, Hoke M, Salzl P, Schwengerer B, Ulbrich G, Payer BA, et al. von Willebrand factor as new noninvasive predictor of portal hypertension, decompensation and mortality in patients with liver cirrhosis. Hepatology 2012;56:1439-1447.
5. Randi AM, Laffan MA. Von Willebrand factor and angiogenesis: basic and applied issues. J Thromb Haemost 2017;15:13-20.
6. Albornoz L, Alvarez D, Otaso JC, Gadano A, Salviu J, Gerona S, Sorroche P, et al. Von Willebrand factor could be an index of endothelial dysfunction in patients with cirrhosis: relationship to degree of liver failure and nitric oxide levels. J Hepatol 1999;30:451-455.