Validation of risk scores for allograft failure after liver transplantation in Germany: a retrospective cohort analysis

Abstract

A growing number of clinical risk scores have been proposed to predict allograft failure after liver transplantation. However, validation of currently available scores in the Eurotransplant region is still lacking. We aimed to analyze all clinically relevant donor and recipient risk scores on a large German liver transplantation data set and performed a retrospective cohort analysis of liver transplantations performed at the Charité—Universitätsmedizin Berlin from January 2007 until December 2021 with organs from donation after brain death. We analyzed 9 previously published scores in 906 liver transplantations [Eurotransplant donor risk index (ET-DRI/DRI), donor age and model for end-stage liver disease (D-MELD), balance of risk (BAR), early allograft dysfunction (EAD), model for early allograft function (MEAF), liver graft assessment following transplantation (L-GrAFT7), early allograft failure simplified estimation (EASE), and a score by Rhu and colleagues). The EASE score had the best predictive value for 3-month, 6-month, and 12-month graft survival with a c-statistic of 0.8, 0.77, and 0.78, respectively. In subgroup analyses, the EASE score was suited best for male recipients with a high-MELD (>25) and an EAD organ. Scores only based on pretransplant data performed worse compared to scores including postoperative data (eg, ET-DRI vs. EAD, p<0.001 at 3-month graft survival). Out of these, the BAR score performed best with a c-statistic of 0.6. This a comprehensive comparison of the clinical utility of risk scores after liver transplantation. The EASE score sufficiently predicted 12-month graft and patient survival. Despite a relatively complex calculation, the EASE score provides significant prognostic value for patients and health care professionals in the Eurotransplant region.

Routine End-ischemic Hypothermic Oxygenated Machine Perfusion in Liver Transplantation from Donors After Brain Death

“…30,40 However, MEAF was chosen as a primary outcome measure for this study as it is a previously well-validated surrogate of early allograft function independently associated with the strongest clinical end-pointtransplant survival. [41][42][43] Importantly, MEAF was a significant predictor of both severe morbidity and mortality in all the patients included in the present study. Although the level of significance was not reached in the dHOPE group, the ORs for the association between MEAF and the development of severe complications were consistent in both arms.…”

“…The choice of primary outcome measure based on laboratory findings in machine perfusion trials is being widely criticized for unknown clinical relevance 30,40 . However, MEAF was chosen as a primary outcome measure for this study as it is a previously well-validated surrogate of early allograft function independently associated with the strongest clinical end-point – transplant survival 41–43 . Importantly, MEAF was a significant predictor of both severe morbidity and mortality in all the patients included in the present study.…”

Spatial inequalities and non-linear association of continuous variables with mortality risk of liver transplantation in Iran: a retrospective cohort study

“…As a result, donor age is less important than before. In addition, the inclusion of other variables and indexes in the model may reduce the effect of donor age, which is not present in our study 46 – 48 .…”

L-GrAFT7 has High Accuracy in Predicting Early Allograft Failure after Liver Transplantation: A Multicenter Cohort Study in China

“… 10 This study found no statistical significance between L-GrAFT 7 and EASE scores, which is consistent with the results reported in a German cohort by Moosburner et al . 25 The difference of the AUROCs in L-GrAFT 7 and L-GrAFT 10 was also small. However, only L-GrAFT can be calculated in the face of possible missing values, 26 and the missing values are mostly obtained between postoperative days 8–10 in clinical practice.…”