Orthotopic liver transplantation (OLT) is the definitive treatment for patients with fulminant liver failure (Status 1A). We aimed to develop a prognostic model for prediction of 30-day mortality of Status 1A candidates on the waiting list. A total of 3,240 candidates from SRTR database were enrolled for model formation (n=2296) and validation (n=944). Through multivariate logistic analysis, independent risk factors were selected to develop the model. Discrimination was evaluated by calculating the area under the curve (AUC) and calibration by calibration plot and the Hosmer-Lemeshow test. Etiology, age, international normalized ratio, bilirubin, ventilator use, ascites, and hepatic encephalopathy were independent predictors for early mortality of Status 1A candidates. The model named as FLF-Transplant Score demonstrated excellent discrimination in training set (AUC: 0.829, 0.809-0.849) and validation set (AUC: 0.805, 0.772-0.838). The calibration plot and the Hosmer-Lemeshow test demonstrated good fitness between prediction and actual results. Cirrhotic patients with a MELD score >40 (1.9%) showed higher 30-day mortality than Status 1A patients with a FLF-transplant score <160 (70.0%). Conclusion: The FLF-Transplant Score shows good discrimination and calibration in predicting on-waiting-list mortality, capable to help decision making for Status 1A and cirrhotic candidates with highest MELD score concerning transplant priority.

CITATION INFORMATION: Guo Z., Chen B., Zhao Q., Xin E., Zhang Z., Wang L., He X., Chen G. Development and Validation of FLF-Transplant Score to Predict Mortality of Status 1A Candidates Am J Transplant. 2017;17 (suppl 3).

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