Benko Tamas, Gallinat Anja, Minor Thomas, Saner Fuat H, Sotiropoulos Georgios C, Paul Andreas, Hoyer Dieter P
Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University Essen-Duisburg, Essen-Duisburg, Germany.
Eur J Gastroenterol Hepatol. 2017 Jun;29(6):716-722. doi: 10.1097/MEG.0000000000000851.
Recently, the postoperative Model for End stage Liver Disease score (POPMELD) was suggested as a definition of postoperative graft dysfunction and a predictor of outcome after liver transplantation (LT).
The aim of the present study was to validate this concept in the context of extended criteria donor (ECD) organs.
Single-center prospectively collected data (OPAL study/01/11-12/13) of 116 ECD LTs were utilized. For each recipient, the Model for End stage Liver Disease (MELD) score was calculated for 7 postoperative days (PODs). The ability of international normalized ratio, bilirubin, aspartate aminotransferase, Donor Risk Index, a recent definition of early allograft dysfunction, and the POPMELD was compared to predict 90-day graft loss. Predictive abilities were compared by receiver operating characteristic curves, sensitivity and specificity, and positive and negative predictive values.
The median Donor Risk Index was 1.8. In all, 60.3% of recipients were men [median age of 54 (23-68) years]. The median POD1-7 peak-aspartate aminotransferase value was 1052 (194-17 577) U/l. The rate of early allograft dysfunction was 22.4%. The 90-day graft survival was 89.7%. Out of possible predictors of the 90-day graft loss MELD on POD5 was the best predictor of outcome (area under the curve=0.84). A MELD score of 16 or more on POD5 predicted the 90-day graft loss with a specificity of 80.8%, a sensitivity of 81.8%, and a positive and negative predictive value of 31 and 97.7%.
A MELD score of 16 or more on POD5 is an excellent predictor of outcome in ECD donor LT. Routine evaluation of POPMELD scores might support clinical decision-making and should be reported routinely in clinical trials.
最近，终末期肝病术后模型评分（POPMELD）被提议作为术后移植物功能障碍的定义以及肝移植（LT）后预后的预测指标。
本研究的目的是在扩大标准供体（ECD）器官的背景下验证这一概念。
利用单中心前瞻性收集的116例ECD肝移植的数据（OPAL研究/01/11 - 12/13）。对于每位受者，计算术后7天（POD）的终末期肝病模型（MELD）评分。比较国际标准化比值、胆红素、天冬氨酸转氨酶、供体风险指数（一种早期移植物功能障碍的最新定义）和POPMELD预测90天移植物丢失的能力。通过受试者工作特征曲线、敏感性和特异性以及阳性和阴性预测值比较预测能力。
供体风险指数中位数为1.8。总体而言，60.3%的受者为男性[中位年龄54（23 - 68）岁]。POD1 - 7天冬氨酸转氨酶峰值中位数为1052（194 - 17577）U/L。早期移植物功能障碍发生率为22.4%。90天移植物存活率为89.7%。在90天移植物丢失的可能预测指标中，POD5时的MELD是最佳预后预测指标（曲线下面积 = 0.84）。POD5时MELD评分≥16预测90天移植物丢失，特异性为80.8%，敏感性为81.8%，阳性和阴性预测值分别为31和97.7%。
POD5时MELD评分≥16是ECD供体肝移植预后的优秀预测指标。对POPMELD评分进行常规评估可能有助于临床决策，并且应在临床试验中常规报告。
