Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, CO, USA.
Colorado Center for Transplantation Care, Research and Education (CCTCARE), Aurora, CO, USA; Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
EBioMedicine. 2023 Apr;90:104505. doi: 10.1016/j.ebiom.2023.104505. Epub 2023 Mar 2.
The estimated long-term survival (EPTS) score is used for kidney allocation. A comparable prognostic tool to accurately quantify EPTS benefit in deceased donor liver transplant (DDLT) candidates is nonexistent.
Using the Scientific Registry of Transplant Recipients (SRTR) database, we developed, calibrated, and validated a nonlinear regression equation to calculate liver-EPTS (L-EPTS) for 5- and 10-year outcomes in adult DDLT recipients. The population was randomly split (70:30) into two discovery (N = 26,372 and N = 46,329) and validation cohorts (N = 11,288 and N = 19,859) for 5- and 10-year post-transplant outcomes, respectively. Discovery cohorts were used for variable selection, Cox proportional hazard regression modeling, and nonlinear curve fitting. Eight clinical variables were selected to construct the L-EPTS formula, and a five-tiered ranking system was created.
Tier thresholds were defined and the L-EPTS model was calibrated (R = 0.96 [5-year] and 0.99 [10-year]). Patients' median survival probabilities in the discovery cohorts for 5- and 10-year outcomes ranged from 27.94% to 89.22% and 16.27% to 87.97%, respectively. The L-EPTS model was validated via calculation of receiver operating characteristic (ROC) curves using validation cohorts. Area under the ROC curve was 82.4% (5-year) and 86.5% (10-year).
L-EPTS has high applicability and clinical utility because it uses easily obtained pre-transplant patients characteristics to accurately discriminate between those who are likely to receive a prolonged survival benefit and those who are not. It is important to evaluate medical urgency alongside survival benefit and placement efficiency when considering the allocation of a scarce resource.
There are no funding sources related to this project.
预计长期生存（EPTS）评分用于肾脏分配。在已故供体肝移植（DDLT）候选人中，没有可比较的预后工具来准确量化 EPTS 获益。
使用 Scientific Registry of Transplant Recipients（SRTR）数据库，我们开发、校准和验证了一个非线性回归方程，以计算成人 DDLT 受者 5 年和 10 年结局的肝-EPTS（L-EPTS）。人群随机分为两组（70:30），即发现队列（N=26372 和 N=46329）和验证队列（N=11288 和 N=19859），分别用于 5 年和 10 年后的移植结局。发现队列用于变量选择、Cox 比例风险回归建模和非线性曲线拟合。选择了 8 个临床变量来构建 L-EPTS 公式，并创建了一个五级分层系统。
定义了层级阈值，并对 L-EPTS 模型进行了校准（R=0.96[5 年]和 0.99[10 年]）。发现队列中患者 5 年和 10 年结局的中位生存率范围分别为 27.94%至 89.22%和 16.27%至 87.97%。使用验证队列通过计算接受者操作特征（ROC）曲线来验证 L-EPTS 模型。ROC 曲线下面积为 82.4%（5 年）和 86.5%（10 年）。
L-EPTS 具有很高的适用性和临床实用性，因为它使用易于获得的移植前患者特征来准确区分那些可能获得延长生存获益的患者和那些不能获得的患者。在考虑稀缺资源的分配时，评估医疗紧迫性和生存获益以及安置效率非常重要。
本项目无资金来源。
