Schrem Harald, Reichert Benedikt, Frühauf Nils, Becker Thomas, Lehner Frank, Kleine Moritz, Bektas Hüseyin, Zachau Lea, Klempnauer Jürgen
General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany.
Ann Transplant. 2012 Jul-Sep;17(3):5-13. doi: 10.12659/aot.883452.
Expansion of the donor pool by the use of grafts with extended donor criteria reduces waiting list mortality with an increased risk for graft and patient survival after liver transplantation. This study investigates the ability of the Donor-Risk-Index (DRI), the Extended-Criteria-Donor-Score (ECD-score) and the D-MELD-score to predict early outcome after liver transplantation.
MATERIAL/METHODS: 291 consecutive adult liver transplants (01.01.2007-31.12.2010) were analysed in a single centre study with ongoing data collection. Primary study endpoints were 30-day mortality, 3-month mortality, 3-month patient and graft survival and the necessity of acute retransplantation within 30 days. For the primary study endpoints ROC-curve analysis was performed to calculate the sensitivity, specificity, and overall model correctness of the Donor-Risk-Index (DRI), Extended-Criteria-Donor-Score (ECD-score) and the D-MELD-Score as predictive models. Cut-off values were selected with the best Youden index.
ROC-curve analysis showed areas under the curve (AUROCs) <0.7 for the DRI, the ECD-Score and the D-MELD-Score as models for the prediction of 30-day mortality, 3-month mortality, 3-month patient survival, 3-month graft survival as well as the necessity of acute retransplantation within 30 days after transplantation with unacceptable low levels of overall model correctness (<62%) and specificity (<56%).
The DRI, the ECD-Score and the D-MELD-Score all fail to predict short-term outcome after liver transplantation with acceptable overall model correctness in a current European transplant setting.
通过使用具有扩展供体标准的移植物来扩大供体库，可降低等待名单上的死亡率，但肝移植后移植物和患者存活风险会增加。本研究调查了供体风险指数（DRI）、扩展标准供体评分（ECD评分）和D-MELD评分预测肝移植早期结局的能力。
材料/方法：在一项持续收集数据的单中心研究中，分析了291例连续的成人肝移植病例（2007年1月1日至2010年12月31日）。主要研究终点为30天死亡率、3个月死亡率、3个月患者和移植物存活率以及30天内急性再次移植的必要性。对于主要研究终点，进行ROC曲线分析，以计算供体风险指数（DRI）、扩展标准供体评分（ECD评分）和D-MELD评分作为预测模型的敏感性、特异性和总体模型正确性。选择具有最佳约登指数的临界值。
ROC曲线分析显示，作为预测30天死亡率、3个月死亡率、3个月患者存活率、3个月移植物存活率以及移植后30天内急性再次移植必要性的模型，DRI、ECD评分和D-MELD评分的曲线下面积（AUROCs）<0.7，总体模型正确性（<62%）和特异性（<56%）处于不可接受的低水平。
在当前欧洲移植环境中，DRI、ECD评分和D-MELD评分均无法以可接受的总体模型正确性预测肝移植后的短期结局。
