Wang Shuai, Lin Xiaohong, Li Yefu, Xie Zhonghao, Zhang Ming, Liang Yicheng, Zhu Chuchen, Dong Yuqi, Zeng Ping, He Xiaoshun, Ju Weiqiang, Chen Maogen
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China.
Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.
Ann Med. 2025 Dec;57(1):2458212. doi: 10.1080/07853890.2025.2458212. Epub 2025 Feb 4.
In addition to surgical technology, successful liver transplantation (LT) depends on perioperative management, which needs an effective prognostic index. Therefore, a simplified and sensitive postoperative index for adult LT should be developed.
In total, 906 patients who underwent LT were included in this cross-sectional study. Univariate analysis was used to identify the independent risk factors for recipient survival. Multivariate logistic and stepwise regression analyses were used to construct and simplify the model design. Area under the curve (AUC) and Kaplan-Meier's (K-M) analysis demonstrated superiority of the new index. The postoperative survival score (POSS) index was further simplified via restricted cubic spline (RCS) analysis. Finally, the interpretation of the long-term mortality and subgroup analyses extended the application of the POSS index.
Finally, a total of five factors (donor sex, recipient body mass index (BMI), total bilirubin (Tbil), international normalized ratio (INR) and total operative time) were identified as independent risk parameters and included in our POSS index. The AUCs of the original and simplified POSS indices were 0.764 and 0.723, respectively. Patients with high scores had poor short-term survival. Our index also functioned well in predicting long-term mortality, and it was more effective for patients with hepatitis B cirrhosis or hepatocellular carcinoma (HCC).
We constructed a simplified and effective postoperative survival scoring index to predict short-term complications and survival in adult LT patients.
除手术技术外，肝移植（LT）的成功还取决于围手术期管理，这需要一个有效的预后指标。因此，应开发一种针对成人LT的简化且敏感的术后指标。
本横断面研究共纳入906例行LT的患者。采用单因素分析确定受者生存的独立危险因素。采用多因素逻辑回归和逐步回归分析构建并简化模型设计。曲线下面积（AUC）和Kaplan-Meier（K-M）分析证明了新指标的优越性。通过受限立方样条（RCS）分析进一步简化术后生存评分（POSS）指数。最后，对长期死亡率的解读和亚组分析扩展了POSS指数的应用。
最终，共确定了五个因素（供者性别、受者体重指数（BMI）、总胆红素（Tbil）、国际标准化比值（INR）和总手术时间）作为独立风险参数，并纳入我们的POSS指数。原始和简化后的POSS指数的AUC分别为0.764和0.723。评分高的患者短期生存较差。我们的指数在预测长期死亡率方面也表现良好，对乙型肝炎肝硬化或肝细胞癌（HCC）患者更有效。
我们构建了一个简化有效的术后生存评分指数，以预测成人LT患者的短期并发症和生存情况。
