Comprehensive Validation of Different Clinical Prediction Models on Short- and Long-Term Outcome Following Orthotopic Liver Transplantation
1Department of Surgery and Transplantation, University Hospital RWTH, Aachen, Germany
2Department of Internal Medicine III, University Hospital RWTH, Aachen, Germany.
Meeting: 2018 American Transplant Congress
Abstract number: C229
Session Information
Date: Monday, June 4, 2018
Session Name: Poster Session C: Liver: Recipient Selection
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Background: Organ shortage remains a major problem in orthotopic liver transplantation (OLT). An optimal utilization of the donor pool with better prediction of outcome is of upmost clinical importance.We investigated the prognostic value of the Balance-of-Risk-BAR, Survival-Outcomes-Following-Liver-Transplant-SOFT, Preallocation-Survival-Outcomes-Following-Liver-Transplant-pSOFT, Donor-Risk-Index-DRI and the Eurotransplant-Donor-Risk-Index-ET-DRI for better stratification of early- and long-term outcome after OLT.
Methods: 322 patients underwent OLT at our institution (5/2010-6/2017). Evaluation of prognostic models was performed by calculating the area under the receiver operating characteristic curve (AUROC) for prediction of 90-days-survival and major postoperative complications (Clavien-Dindo; CD>2). Cut-off values were determined using the Youden-index. Patient- and graft-survival were analyzed using the Kaplan-Meier method and the log-rank test. 90-d complications were assessed using the CD and comprehensive-complication-index (CCI). Parametric and non-parametric tests have been utilized for subgroup analysis.
Results: ROC-curve analysis showed AUCs <0.7 for DRI and ET-DRI as prediction models for 90-d survival and complications. The BAR, SOFT, and pSOFT showed AUCs>0.7 with good prediction of early survival. Only the BAR showed AUC >0.7 for morbidity. 5-yrs. patient survival was 81% for BAR<14 vs. 69% for BAR>14 (p=0.037), 82% for pSOFT<28 vs. 50% for pSOFT >28 (p<0.0001), and 82% for SOFT<22 vs. 58% for SOFT>22 (p=0.0003) respectively. 5-yrs. graft survival was 78% for BAR<14 vs. 67% for BAR>14 (p=0.081), 79% for pSOFT<28 vs. 50% for pSOFT >28 (p<0.0001), and 78% for SOFT<22 vs. 58% for SOFT>22 (p=0.0004) respectively. Stratifying by BAR, pSOFT and SOFT, subgroup-analysis showed significant differences (p<0.001) in CCI, intensive-care and hospital-stay.
Conclusions: The overall prognostic value of the DRI and ET-DRI scores was disappointing. The BAR-, pSOFT-, and SOFT-scores are useful in clinical decision making. Of all scores tested, the BAR-score had the best value in predicting both morbidity and mortality after OLT.
CITATION INFORMATION: Boecker J., Czigany Z., Bednarsch J., Amygdalos I., Meister F., Morales Santana D., Schoening W., Ulmer T., Krebbers M., Koek G., Kroy D., Tacke F., Trautwein C., Neumann U., Lurje G. Comprehensive Validation of Different Clinical Prediction Models on Short- and Long-Term Outcome Following Orthotopic Liver Transplantation Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Boecker J, Czigany Z, Bednarsch J, Amygdalos I, Meister F, Santana DMorales, Schoening W, Ulmer T, Krebbers M, Koek G, Kroy D, Tacke F, Trautwein C, Neumann U, Lurje G. Comprehensive Validation of Different Clinical Prediction Models on Short- and Long-Term Outcome Following Orthotopic Liver Transplantation [abstract]. https://atcmeetingabstracts.com/abstract/comprehensive-validation-of-different-clinical-prediction-models-on-short-and-long-term-outcome-following-orthotopic-liver-transplantation/. Accessed June 3, 2020.« Back to 2018 American Transplant Congress