Division of Abdominal Transplantation and Division of Hepatobiliary Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
Department of Surgery, Texas Children's Hospital, Houston, TX.
Am J Transplant. 2015 Jul;15(7):1855-63. doi: 10.1111/ajt.13190. Epub 2015 Feb 17.
A prognostic index to predict survival after liver transplantation could address several clinical needs. Here, we devised a scoring system that predicts recipient survival after pediatric liver transplantation. We used univariate and multivariate analysis on 4565 pediatric liver transplant recipients data and identified independent recipient and donor risk factors for posttransplant mortality at 3 months. Multiple imputation was used to account for missing variables. We identified five factors as significant predictors of recipient mortality after pediatric liver transplantation: two previous transplants (OR 5.88, CI 2.88-12.01), one previous transplant (OR 2.54, CI 1.75-3.68), life support (OR 3.68, CI 2.39-5.67), renal insufficiency (OR 2.66, CI 1.84-3.84), recipient weight under 6 kilograms (OR 1.67, CI 1.12-2.36) and cadaveric technical variant allograft (OR 1.38, CI 1.03-1.83). The Survival Outcomes Following Pediatric Liver Transplant score assigns weighted risk points to each of these factors in a scoring system to predict 3-month recipient survival after liver transplantation with a C-statistic of 0.74. Although quite accurate when compared with other posttransplant survival models, we would not advocate individual clinical application of the index.
一个用于预测肝移植后生存的预后指标可以满足几个临床需求。在这里，我们设计了一个评分系统，用于预测儿童肝移植后的受者生存率。我们对 4565 例儿童肝移植受者的数据进行了单因素和多因素分析，确定了与移植后 3 个月死亡相关的独立受者和供者危险因素。我们使用多重插补来处理缺失变量。我们确定了五个因素是儿童肝移植后受者死亡的显著预测因素：两次以上移植（OR5.88，95%CI2.88-12.01）、一次移植（OR2.54，95%CI1.75-3.68）、生命支持（OR3.68，95%CI2.39-5.67）、肾功能不全（OR2.66，95%CI1.84-3.84）、受者体重<6 公斤（OR1.67，95%CI1.12-2.36）和尸体技术变异同种异体移植物（OR1.38，95%CI1.03-1.83）。“儿童肝移植后生存评分”在评分系统中为每个因素分配加权风险点，以预测肝移植后 3 个月受者的生存率，其 C 统计量为 0.74。虽然与其他移植后生存模型相比，该评分相当准确，但我们不主张在临床上单独应用该指标。
