Schrem Harald, Focken Moritz, Gunson Bridget, Reichert Benedikt, Mirza Darius, Kreipe Hans-Heinrich, Neil Desley, Kaltenborn Alexander, Goldis Alon, Krauth Christian, Roberts Keith, Becker Thomas, Klempnauer Jürgen, Neuberger James
Core Facility Quality Management and Health Technology Assessment in Transplantation, Integrated Research and Treatment Center Transplantation.
General, Visceral, and Transplant Surgery.
Liver Transpl. 2016 Jun;22(6):743-56. doi: 10.1002/lt.24421.
Prognostic models for the prediction of 90-day mortality after transplantation with pretransplant donor and recipient variables are needed to calculate transplant benefit. Transplants in adult recipients in Germany (Hannover, n = 770; Kiel, n = 234) and the United Kingdom (Birmingham, n = 829) were used for prognostic model design and validation in separate training and validation cohorts. The survival benefit of transplantation was estimated by subtracting the observed posttransplant 90-day mortality from the expected 90-day mortality without transplantation determined by the Model for End-Stage Liver Disease (MELD) score. A prognostic model called the liver allocation score (LivAS) was derived using a randomized sample from Hannover using pretransplant donor and recipient variables. This model could be validated in the German training and validation cohorts (area under the receiver operating characteristic curve [AUROC] > 0.70) but not in the English cohort (AUROC, 0.58). Although 90-day mortality rates after transplantation were 13.7% in Hannover, 12.1% in Kiel, and 8.3% in Birmingham, the calculated 90-day survival benefits of transplantation were 6.8% in Hannover, 7.8% in Kiel, and 2.8% in Birmingham. Deployment of the LivAS for limiting allocation to donor and recipient combinations with likely 90-day survival as indicated by pretransplant LivAS values below the cutoff value would have increased the survival benefit to 12.9% in the German cohorts, whereas this would have decreased the benefit in England to 1.3%. The English and German cohorts revealed significant differences in 21 of 28 pretransplant variables. In conclusion, the LivAS could be validated in Germany and may improve German allocation policies leading to greater survival benefits, whereas validation failed in England due to profound differences in the selection criteria for liver transplantation. This study suggests the need for national prognostic models. Even though the German centers had higher rates of 90-day mortality, estimated survival benefits were greater. Liver Transplantation 22 743-756 2016 AASLD.
需要利用移植前供体和受体变量来预测移植后90天死亡率的预后模型，以计算移植效益。德国（汉诺威，n = 770；基尔，n = 234）和英国（伯明翰，n = 829）成年受体的移植数据被用于在单独的训练和验证队列中进行预后模型的设计和验证。移植的生存效益通过将观察到的移植后90天死亡率，从由终末期肝病模型（MELD）评分确定的无移植情况下预期的90天死亡率中减去来估算。利用来自汉诺威的随机样本，采用移植前供体和受体变量得出了一个名为肝脏分配评分（LivAS）的预后模型。该模型在德国的训练和验证队列中得到了验证（受试者操作特征曲线下面积[AUROC]>0.70），但在英国队列中未得到验证（AUROC为0.58）。尽管汉诺威移植后90天死亡率为13.7%，基尔为12.1%，伯明翰为8.3%，但计算得出的移植后90天生存效益在汉诺威为6.8%，基尔为7.8%，伯明翰为2.8%。根据移植前LivAS值低于临界值所表明的可能90天生存率，运用LivAS限制供体和受体组合的分配，在德国队列中可将生存效益提高到12.9%，而在英国则会将效益降低到1.3%。英国和德国队列在28个移植前变量中的21个变量上显示出显著差异。总之，LivAS在德国得到了验证，可能会改善德国导致更大生存效益的分配政策，而在英国由于肝移植选择标准存在深刻差异，验证失败。这项研究表明需要建立国家预后模型。尽管德国中心的90天死亡率较高，但估计的生存效益更大。《肝脏移植》22 743 - 756 2016美国肝脏病研究协会
