Rana A, Hardy M A, Halazun K J, Woodland D C, Ratner L E, Samstein B, Guarrera J V, Brown R S, Emond J C
Division of Abdominal Organ Transplantation, Columbia University College of Physicians and Surgeons, New York, NY, USA.
Am J Transplant. 2008 Dec;8(12):2537-46. doi: 10.1111/j.1600-6143.2008.02400.x. Epub 2008 Sep 25.
It is critical to balance waitlist mortality against posttransplant mortality. Our objective was to devise a scoring system that predicts recipient survival at 3 months following liver transplantation to complement MELD-predicted waitlist mortality. Univariate and multivariate analysis on 21,673 liver transplant recipients identified independent recipient and donor risk factors for posttransplant mortality. A retrospective analysis conducted on 30,321 waitlisted candidates reevaluated the predictive ability of the Model for End-Stage Liver Disease (MELD) score. We identified 13 recipient factors, 4 donor factors and 2 operative factors (warm and cold ischemia) as significant predictors of recipient mortality following liver transplantation at 3 months. The Survival Outcomes Following Liver Transplant (SOFT) Score utilized 18 risk factors (excluding warm ischemia) to successfully predict 3-month recipient survival following liver transplantation. This analysis represents a study of waitlisted candidates and transplant recipients of liver allografts after the MELD score was implemented. Unlike MELD, the SOFT score can accurately predict 3-month survival following liver transplantation. The most significant risk factors were previous transplantation and life support pretransplant. The SOFT score can help clinicians determine in real time which candidates should be transplanted with which allografts. Combined with MELD, SOFT can better quantify survival benefit for individual transplant procedures.
平衡等待名单上的死亡率和移植后的死亡率至关重要。我们的目标是设计一种评分系统，以预测肝移植后3个月时受者的生存情况，从而补充终末期肝病模型（MELD）预测的等待名单死亡率。对21673例肝移植受者进行的单因素和多因素分析确定了移植后死亡率的独立受者和供者风险因素。对30321例等待名单上的候选者进行的回顾性分析重新评估了终末期肝病模型（MELD）评分的预测能力。我们确定了13个受者因素、4个供者因素和2个手术因素（热缺血和冷缺血），作为肝移植后3个月时受者死亡率的重要预测因素。肝移植后生存结果（SOFT）评分利用18个风险因素（不包括热缺血）成功预测了肝移植后3个月时受者的生存情况。该分析是在实施MELD评分后对等待名单上的候选者和肝同种异体移植受者进行的一项研究。与MELD不同，SOFT评分可以准确预测肝移植后3个月的生存情况。最显著的风险因素是既往移植和移植前的生命支持。SOFT评分可以帮助临床医生实时确定哪些候选者应该接受哪种同种异体移植。与MELD相结合，SOFT可以更好地量化个体移植手术的生存获益。
