**3. Results**

Of the 144 patients, 94 (65.2%) were male and 50 (34.7%) females. Everyone had a minimal follow up of 36 months with a mean of 43.27 ± 12.97, minimum of three months for those who died and up to 73 months for the rest.

The average age was 47.8 years with a standard deviation of 12.9. Younger age was 18 years old and the oldest 87. The group with the highest number was between 40 and 60 years old with 84 patients (58.35%) as shown in Table 2.


Table 2. Baseline characteristics of all patients

The most common cause of cirrhosis in the study was HCV (42 patients, 29.1%), followed by alcohol (33 patients, 22.9%). The group "others" (46 patients, 31.9%) involved autoimmune hepatitis, primary biliary cirrhosis, sclerosing cholangitis, Wilson's disease, congenital hepatic fibrosis and cryptogenic (Table 3).


Table 3. Etiology of cirrhosis

130 Liver Transplantation – Basic Issues

Parameter A B C Ascites none slight-moderate tense Hepatic encephalopathy (grade) none I-II III-IV Serum bilirubin (μmol/L) <51 51-102 >102 Serum albumin (g/L) >34 25-34 <25 Prothrombin time (%) >60 46-60 <46 Score 5 to 6 7 to 9 10 to 15 The total score classifies patients into grade A, B, or C (ordinal scale) according to the points on continuous 5-15-point scale, which depends on ascites, encephalopathy, jaundice, serum albumin, and

Table 1. Child-Pugh classification for the survival prognosis in liver cirrhosis

The data were processed using SPSS 13.0 for Windows. The results are presented as means ± standard deviations and confidence intervals of 95% for quantitative variables and as percentages for categorical variables. For comparison of continuous variables the t test comparison of independent means and chi-square test to compare categorical variables was used. Survival analysis was performed using the Kaplan-Meier curves; we used the cutoff points at 36 months (three years). We performed a Cox regression analysis to estimate the independent effects of potential predictors of survival that had been significant in univariate

Of the 144 patients, 94 (65.2%) were male and 50 (34.7%) females. Everyone had a minimal follow up of 36 months with a mean of 43.27 ± 12.97, minimum of three months for those

The average age was 47.8 years with a standard deviation of 12.9. Younger age was 18 years old and the oldest 87. The group with the highest number was between 40 and 60 years old

Follow-up time (months) 43.27 ± 12.97 (3-73)

Age (years) 47.8 ± 12.97 (18-87)

The most common cause of cirrhosis in the study was HCV (42 patients, 29.1%), followed by alcohol (33 patients, 22.9%). The group "others" (46 patients, 31.9%) involved autoimmune hepatitis, primary biliary cirrhosis, sclerosing cholangitis, Wilson's disease, congenital

All patients 144

Sex (Male/Female) 94/50

<40 years 33 (22.9%) 40–60 years 84 (58.3%) >60 years 27 (18.8%)

prothrombin time prolongation(Pugh RNH, 1973)

analysis. For all tests a significant level of 0.05 was set.

who died and up to 73 months for the rest.

with 84 patients (58.35%) as shown in Table 2.

Table 2. Baseline characteristics of all patients

hepatic fibrosis and cryptogenic (Table 3).

**2.2 Statistical analysis** 

**3. Results** 

Child-Pugh classification

Table 4 and 5 show the clinical and laboratory characteristics of all patients. At the beginning of the evaluation 40 (27.7%) had not developed complications of cirrhosis and 104 (72.2%) had one or more of them.


Table 4. Clinical characteristics

According to Child-Pugh stages predominated A (56 patients, 38.8%), followed by B (46 patients, 31.9%) and C (42 patients, 29.1%). The average score was 8.02 ± 2.6. The mean MELD score was: 13.36 ± 5.74.


Table 5. Laboratory characteristics

96 patients showed esophageal varices (66.7%). Of these, 15 (37.5%) were in compensated stage and 81 (77.8%) in the decompensated one. Of these, 35 (24.3%) had at least one episode of gastrointestinal bleeding.

The most frequent complication was ascites (92 patients, 63.9%), followed by bleeding from esophageal varices (35 patients, 24.3%) and hepatic encephalopathy (21 patients, 14.6%). Seven patients were diagnosed with hepatocellular carcinoma during follow-up and in two patients who were in Child A stage, it was considered as the cause of decompensation.

#### **3.1 Survival of patients at three years**

Of the 144 patients studied, 65 (45.1%) died from complications of liver cirrhosis between January 2004 and April 2011. Overall survival was 62.5% at three years follow-up, with a mean of 48.05 months and 95% between 43.2-52.8 months (see Figure 1).

As shown in Figure 2 and Table 6, survival of patients with compensated liver cirrhosis was 85% at three years with a mean of 60.27 months (CI 53.96-66.58). Patients who had complications had a survival rate of 53.8% with a mean of 42.4 months (CI 36.59-48.20) (p <0.001). Of the patients with compensated liver cirrhosis at a baseline, the seven who died during the follow-up period were due to complications of the disease. Two of them presented HCC.


Table 6. Survival of patients with compensated and decompensated liver cirrhosis

As presented in Table 7, univariate analysis showed continuous variables that were associated with significantly poorer survival such as, age of the patients (p = 0.017), bilirubin (p = 0.04), albumin (p <0.001 ), the INR (p <0.001), Child-Pugh score (p <0.001) and MELD score (p <0.001). Creatinine did not behave the same way (p = 0.779).

Categorical variables that were associated with a significantly lower survival were, male sex (p = 0.033), history of ascites (p = 0,001), of hepatic encephalopathy (p = 0.032), and the development of hepatocellular carcinoma (p = 0.003). The bleeding, did not behave the same way. (Table 7).


Table 7. Clinical and biochemical characteristics of the 144 cirrhotic patients at 3 years follow-up

Fig. 1. Overall survival

Seven patients were diagnosed with hepatocellular carcinoma during follow-up and in two patients who were in Child A stage, it was considered as the cause of decompensation.

Of the 144 patients studied, 65 (45.1%) died from complications of liver cirrhosis between January 2004 and April 2011. Overall survival was 62.5% at three years follow-up, with a

As shown in Figure 2 and Table 6, survival of patients with compensated liver cirrhosis was 85% at three years with a mean of 60.27 months (CI 53.96-66.58). Patients who had complications had a survival rate of 53.8% with a mean of 42.4 months (CI 36.59-48.20) (p <0.001). Of the patients with compensated liver cirrhosis at a baseline, the seven who died during the follow-up period were due to complications of the disease. Two of them

> **Cirrhosis Median (months) CI 95% P**  Compensated 60.27 53.96 – 66.58 p<0.001

As presented in Table 7, univariate analysis showed continuous variables that were associated with significantly poorer survival such as, age of the patients (p = 0.017), bilirubin (p = 0.04), albumin (p <0.001 ), the INR (p <0.001), Child-Pugh score (p <0.001) and MELD score

Categorical variables that were associated with a significantly lower survival were, male sex (p = 0.033), history of ascites (p = 0,001), of hepatic encephalopathy (p = 0.032), and the development of hepatocellular carcinoma (p = 0.003). The bleeding, did not behave the same

**Value Surviving Deceased p** 

Sex (male/female) 46/33 48/17 0.033 Age (years, SD) 45.4 ± 13.2 50.66 ± 12.09 0.017 Previous ascites (yes/no) 41/38 51/14 0.001 Previous encephalopathy (yes/no) 7/72 14/51 0.032 Hepatocellular carcinoma (yes/no) 0/79 7/58 <0.001 Previous variceal bleeding (yes/no) 18/61 17/48 0.639 Compensated cirrhosis (yes/no) 32/47 8/57 <0.001 Bilirubin (µmol/L) 35.18 ± 50.18 63.72 ± 66 0.04 Albumin (g/L) 37.56 ± 7.74 29.97 ± 7.03 <0.001 INR 1.31 ± 0.49 1.62 ± 0.49 <0.001 Creatinine (µmol/L) 84.03 ± 24.6 82.94 ± 26.32 0.779 Child- Pugh score 7.0 ± 2.1 9.27 ± 2.63 <0.001 MELD score 11.45 ± 4.99 15.67 ± 5.77 <0.001 Table 7. Clinical and biochemical characteristics of the 144 cirrhotic patients at 3 years follow-up

Patients 79 65

Decompensated 42.40 36.59 – 48.20 Table 6. Survival of patients with compensated and decompensated liver cirrhosis

(p <0.001). Creatinine did not behave the same way (p = 0.779).

mean of 48.05 months and 95% between 43.2-52.8 months (see Figure 1).

**3.1 Survival of patients at three years** 

presented HCC.

way. (Table 7).

Fig. 2. Survival of patients with compensated and decompensated liver cirrhosis

In the analysis of the survival curves of Kaplan-Meier, categorical variables that had significantly lower survival were male gender (56.4%, average 43.69, 47.56-61.0), the history of ascites (51.1%, average 41.3 months; 35,06-47.53) hepatic encephalopathy (38.1%, mean 30.85 months, 17.67, 44.04), the development of hepatocellular carcinoma (0%, average 11.42, 4.09-18.76) and Child-Pugh stages with 80.8% survival for stage A, 69.9% for B and 31% for C (Table 8). Upper gastrointestinal bleeding for varicose veins was not associated with survival.


Table 8. Univariate analysis of categorical variables to three years of survival


Table 9. Predictors of survival of liver cirrhosis at 3 years follow- up Cox regression
