Potential value and limitations of different clinical scoring systems in the assessment of short- and long-term outcome following orthotopic liver transplantation

Abstract

BackgroundIn 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.MethodsWe 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.ResultsBAR, 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.ConclusionsOut 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.

The role of recipient myosteatosis in graft and patient survival after deceased donor liver transplantation

“…11,12 Because of that, a careful selection and matching of donors and recipients are essential to improve allograft utilization and post-orthotopic liver transplantation (OLT) outcomes. 13 Recent studies by our group and others demonstrated a high prevalence of BC alterations in patients with end-stage liver disease. In particular, myosteatosis was identified as an important prognostic factor in predicting adverse perioperative outcomes in patients undergoing OLT.…”

Ischemia-Reperfusion Injury in Marginal Liver Grafts and the Role of Hypothermic Machine Perfusion: Molecular Mechanisms and Clinical Implications

“…The term ECD comprises a heterogenous group of different graft types with distinct functional impairments and an increased susceptibility to IRI [6,35]. Based on the growing obesity epidemic, steatotic grafts have emerged as an essential part of the ECD donor pool [36].…”

Abdominal Organ Transplantation: Noteworthy Literature in 2019

“…Boecker and associates aimed to comparatively investigate the association of 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 outcomes following LT. 52 Ninety-day mortality following LT was chosen as the primary endpoint for the assessment of the predictive abilities of the various scores. They included 328 LTs consecutively performed between 2010 and 2017 at a single institution in the analysis.…”

“…They suggested that only the BAR score could predict 90-day major morbidity and mortality with high accuracy (AUROC > 0.700). 52 Regarding biomarkers for prediction of post-LT outcomes, Baron-Stefaniak and coinvestigators studied whether the serum concentration of the cytokine Ddopachrome tautomerase (D-DT; or macrophage migration inhibitory factor [MIF]-2) in patients undergoing LT was associated with survival and acute kidney injury (AKI). 53 D-DT, a lymphokine, is a functional homologue of MIF, is ubiquitously stored in intracellular vesicles of human cells, and it is rapidly released into the circulating blood on stimulation.…”