Department of Surgery and Transplantation, University Hospital RWTH Aachen, Aachen, Germany.
Department of Internal Medicine III, University Hospital RWTH Aachen, Aachen, Germany.
PLoS One. 2019 Mar 21;14(3):e0214221. doi: 10.1371/journal.pone.0214221. eCollection 2019.
In an attempt to further improve liver allograft utilization and outcome in orthotopic liver transplantation (OLT), a variety of clinical scoring systems have been developed. Here we aimed to comparatively investigate the association of the Balance-of-Risk (BAR), Survival-Outcomes-Following-Liver-Transplant (SOFT), Preallocation-Survival-Outcomes-Following-Liver-Transplant (pSOFT), Donor-Risk-Index (DRI), and the Eurotransplant-Donor-Risk-Index (ET-DRI) scores with short- and long-term outcome following OLT.
We included 338 consecutive patients, who underwent OLT in our institution between May 2010 and November 2017. For each prognostic model, the optimal cutoff values were determined with the help of the Youden-index and their diagnostic accuracy for 90-day post OLT-mortality and major postoperative complications was measured by the area under the receiver operating characteristic curve (AUROC). Patient- and graft survival were analyzed using the Kaplan-Meier method and the log-rank test. Morbidity was assessed using the Clavien-Dindo classification and the Comprehensive-Complication-Index.
BAR, SOFT, and pSOFT performed well above the conventional AUROC-threshold of 0.70 with good prediction of early mortality. Only BAR showed AUC>0.70 for both mortality and major morbidity. With the cutoffs of 14, 31, and 22 respectively for BAR, SOFT, and pSOFT, subgroup analysis showed significant differences (p<0.001) in morbidity and mortality, length of intensive care- and hospital-stay and early allograft dysfunction rates. Five-years patient survival was inferior in the high BAR, pSOFT, and SOFT groups.
Out of all scores tested, the BAR-score had the best value in predicting both 90-day morbidity and mortality after OLT showing the highest AUCs. The pSOFT and SOFT scores demonstrated an acceptable accuracy in predicting 90-day morbidity and mortality. The used BAR, SOFT, and pSOFT cutoffs allowed the identification of patients at risk in terms of five-year patient survival. The DRI and ET-DRI scores have failed to predict recipient outcomes in the present setting.
为了进一步提高原位肝移植（OLT）中肝移植物的利用率和结果，开发了多种临床评分系统。在这里，我们旨在比较研究平衡风险（BAR）、肝移植后生存结果（SOFT）、预分配肝移植后生存结果（pSOFT）、供体风险指数（DRI）和 Eurotransplant-Donor-Risk-Index（ET-DRI）评分与 OLT 后短期和长期结果的关系。
我们纳入了 2010 年 5 月至 2017 年 11 月期间在我院接受 OLT 的 338 例连续患者。对于每个预后模型，我们使用约登指数确定最佳截断值，并通过接受者操作特征曲线下的面积（AUROC）测量其对 OLT 后 90 天死亡率和主要术后并发症的诊断准确性。使用 Kaplan-Meier 方法和对数秩检验分析患者和移植物的存活率。使用 Clavien-Dindo 分类和综合并发症指数评估发病率。
BAR、SOFT 和 pSOFT 的表现均优于 0.70 的传统 AUROC 阈值，对早期死亡率有很好的预测作用。只有 BAR 对死亡率和主要发病率均表现出 AUC>0.70。对于 BAR、SOFT 和 pSOFT，分别使用 14、31 和 22 的截断值，亚组分析显示在发病率和死亡率、重症监护和住院时间以及早期移植物功能障碍率方面存在显著差异（p<0.001）。高 BAR、pSOFT 和 SOFT 组的五年患者生存率较低。
在所测试的所有评分中，BAR 评分在预测 OLT 后 90 天发病率和死亡率方面具有最佳价值，AUC 最高。pSOFT 和 SOFT 评分在预测 90 天发病率和死亡率方面具有可接受的准确性。所使用的 BAR、SOFT 和 pSOFT 截断值允许根据五年患者生存率识别处于危险中的患者。在目前的情况下，DRI 和 ET-DRI 评分未能预测受体结局。
