4 Unless there is a commensurate

increase in organ donation, the number of patients awaiting OLT and liver transplant waiting list mortality will increase. To manage liver transplant waiting lists in an optimal fashion, predictors of waiting list mortality—in addition to MELD—will be required. Serum ferritin concentration (SF) is a widely available and easily measured biochemical parameter. SF is increased in patients with elevated body iron stores, hepatic necroinflammatory activity, and systemic inflammatory RGFP966 states.5, 6 These causes of increased SF may be associated with an increased risk of clinical deterioration and progressive liver dysfunction. Therefore, we hypothesized that an elevated SF may be an important predictor of mortality in patients awaiting OLT. In this study, we measured SF in patients awaiting OLT, and our results suggest that it is an important predictor of death on the liver transplantation waiting list—independent of the baseline MELD score. HCC, hepatocellular carcinoma; HR, hazard ratio; MELD, model for end stage buy Buparlisib liver disease; OLT, orthotopic liver transplantation; ROC, receiver operating characteristic; SF, serum ferritin concentration; UCLA, University of California Los Angeles. Two hundred sixty-six adults were listed for OLT by

The Queensland Liver Transplant Service between January 2000 and June 2006. Twelve retransplantations, 14 primary liver transplant recipients with fulminant liver failure, 48 subjects with noncirrhotic liver diseases, and a single subject with C282Y-related hemochromatosis were excluded from

the analysis, resulting in a study population of 191 subjects. Patient demographics, cause of their cirrhosis, and indication for OLT were confirmed by review of patients’ medical records, relevant laboratory investigations, and explant histology. Patients were L-gulonolactone oxidase followed until their death, OLT, or the end of the study period (June 2007). Observations ended after any of these primary end-points. The study was approved by the Princess Alexandra Hospital Research Ethics Committee and the University of California Los Angeles (UCLA) Research Ethics Review Board. No donor organs were obtained from executed prisoners or other institutionalized persons. The patients in the study cohort were divided into three groups on the basis of their fasting SF measured at the time of their listing for OLT. Serum ferritin concentration was analyzed as a trichotomous variable, with preselected cutoff values of less than 200 μg/L, 200 to 400 μg/L, and more than 400 μg/L. The separation of patients into these three groups was based on local laboratory reference ranges for SF and represented normal, borderline-elevated, and increased SF levels, respectively. Explant hepatic iron grade was estimated according to the method of Searle et al.