Department of Liver Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, No. 160 Pujian Road, Pudong New District, Shanghai, 200128, China.
Department of Liver Transplantation, Sun Yet-Sen Memorial Hospital, Sun Yat-Sen University, No.107 Yanjiang West Road, Guangzhou, 510080, China.
World J Pediatr. 2024 Mar;20(3):239-249. doi: 10.1007/s12519-023-00766-y. Epub 2023 Oct 24.
Liver transplantation is the main treatment for cholestatic liver disease and some metabolic liver diseases in children. However, no accurate prediction model to determine the survival probability of grafts prior to surgery exists. This study aimed to develop an effective prognostic model for allograft survival after pediatric liver transplantation.
This retrospective cohort study included 2032 patients who underwent pediatric liver transplantation between January 1, 2006, and January 1, 2020. A nomogram was developed using Cox regression and validated based on bootstrap sampling. Predictive and discriminatory accuracies were determined using the concordance index and visualized using calibration curves; net benefits were calculated for model comparison. An online Shiny application was developed for easy access to the model.
Multivariable analysis demonstrated that preoperative diagnosis, recipient age, body weight, graft type, preoperative total bilirubin, interleukin-1β, portal venous blood flow direction, spleen thickness, and the presence of heart disease and cholangitis were independent factors for survival, all of which were selected in the nomogram. Calibration of the nomogram indicated that the 1-, 3-, and 5-year predicted survival rates agreed with the actual survival rate. The concordance indices for graft survival at 1, 3, and 5 years were 0.776, 0.757, and 0.753, respectively, which were significantly higher than those of the Pediatric End-Stage Liver Disease and Child-Pugh scoring systems. The allograft dysfunction risk of a recipient could be easily predicted using the following URL: https://aspelt.shinyapps.io/ASPELT/ / CONCLUSION: The allograft survival after pediatric liver transplantation (ASPELT) score model can effectively predict the graft survival rate after liver transplantation in children, providing a simple and convenient evaluation method for clinicians and patients.
肝移植是治疗儿童胆汁淤积性肝病和一些代谢性肝病的主要方法。然而，目前尚无准确的预测模型可以在术前确定移植物的存活率。本研究旨在建立一种有效的儿童肝移植后同种异体移植物存活的预后模型。
本回顾性队列研究纳入了 2032 名于 2006 年 1 月 1 日至 2020 年 1 月 1 日期间接受儿童肝移植的患者。采用 Cox 回归建立列线图，并通过 bootstrap 抽样进行验证。通过一致性指数确定预测和区分准确性，并通过校准曲线进行可视化；为模型比较计算净效益。开发了一个在线 Shiny 应用程序，以便于访问模型。
多变量分析表明，术前诊断、受体年龄、体重、移植物类型、术前总胆红素、白细胞介素-1β、门静脉血流方向、脾脏厚度以及心脏病和胆管炎的存在是与生存相关的独立因素，这些因素均被选入列线图。列线图的校准表明，1、3 和 5 年的预测生存率与实际生存率一致。1、3 和 5 年移植物存活率的一致性指数分别为 0.776、0.757 和 0.753，明显高于小儿终末期肝病和 Child-Pugh 评分系统。通过以下网址可以轻松预测受者的移植物功能障碍风险：https://aspelt.shinyapps.io/ASPELT/ 。
儿童肝移植后同种异体移植物存活（ASPELT）评分模型可有效预测儿童肝移植后移植物的存活率，为临床医生和患者提供了一种简单方便的评估方法。
