Development and Validation of a Comprehensive Model to Estimate Early Allograft Failure Among Patients Requiring Early Liver Retransplant

Abstract

Key Points Question Can the individual risk estimation for early allograft failure (EAF) be improved in view of liver retransplant? Findings In this multicenter cohort study investigating the association between donor-recipient factors and EAF, a novel Early Allograft Failure Simplified Estimation (EASE) score was developed. The score includes Model for End-stage Liver Disease score, transfused packed red blood cells, and hepatic vessel early thrombosis as well as transaminases, platelet, and bilirubin kinetics as variables on day 10 after transplant. The EASE score outperformed previous model scores, estimating EAF risk with 87% accuracy on day 90 after transplant; EASE was developed on a multicenter Italian database (1609 recipients) and validated on an external UK database (538 recipients). Meaning In this study, the EASE score rated the EAF risk (0%-100%) and identified cases at unsustainable risk to be listed for retransplant.

L-GrAFT and EASE scores in liver transplantation: Need for reciprocal external validation and comparison with other scores

“…Starting from the seminal study by Agopian, (1) we have recently validated the L-GrAFT10 on a population of 1,609 patients transplanted between 2016 and 2017 in 14 Italian centers and obtained a C-statistic of 0.72. (5) Using the original L-GrAFT components, we have further refined and simplified the L-GrAFT10 formula reducing the number of data entries from 40 to 17. The beta-coefficients were recalculated, and additional donor and recipient parameters were tested in eight models.…”

Availability of a Web and Smartphone Application to Stratify the Risk of of Early Allograft Failure Requiring Liver Retransplantation

“…To overcome these limitations, the authors (1) used univariate analysis of several parameters. (3,4) The early allograft failure (EAF) definition allows a quantification of the overall risk of failure at 90 days after LT. EAF would strengthen the analysis from Moosburner et al (1) We recently developed a multivariable score, Early Allograft Failure Simplified Estimation (EASE), to predict EAF and validated it in a large cohort (5) in order to (1) include donor and recipient factors associated with the outcome, (2) obtain the highest C statistic at 30 and 90 days, and (3) be easily implemented clinically.…”

Clinical value and limitations of the preoperative C‐reactive‐protein‐to‐albumin ratio in predicting post‐operative morbidity and mortality after deceased‐donor liver transplantation: a retrospective single‐centre study

“…With this in mind, various prognostic scores have been evaluated and established in the OLT setting, such as the Model of End‐stage Liver Disease (MELD) [9], Balance of Risk (BAR) [6] and Survival Outcomes Following liver Transplantation (SOFT) [7] scores, or the Donor Risk Index (DRI) [11,12]. Newer scores have also been developed, such as the Liver Graft Assessment Following Transplantation (L‐GrAFT) [13] and Early Allograft Failure Simplified Estimation (EASE)[14] scores, which focus on early allograft dysfunction. Some workgroups have created simplified scores (such as Kong et al., who included recipient age, creatinine, bilirubin and albumin (Alb) [15]) or focused on individual parameters, such as post‐operative platelet counts [5], body mass index (BMI) [16], recipient blood type [17] or recipient and donor gender as prognostic markers [18].…”