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

被引:28
作者
Boecker, Joerg [1 ]
Czigany, Zoltan [1 ]
Bednarsch, Jan [1 ]
Amygdalos, Iakovos [1 ]
Meister, Franziska [1 ]
Santana, Daniel Antonio Morales [1 ]
Liu, Wen-Jia [1 ]
Strnad, Pavel [2 ]
Neumann, Ulf Peter [1 ,3 ]
Lurje, Georg [1 ]
机构
[1] Univ Hosp RWTH Aachen, Dept Surg & Transplantat, Aachen, Germany
[2] Univ Hosp RWTH Aachen, Dept Internal Med 3, Aachen, Germany
[3] Maastricht Univ, Med Ctr, Dept Surg, Maastricht, Netherlands
关键词
DONOR RISK INDEX; SURGICAL COMPLICATIONS; GRAFT FAILURE; SOFT SCORE; BAR-SCORE; SURVIVAL; ALLOCATION; MODEL; CLASSIFICATION; VALIDATION;
D O I
10.1371/journal.pone.0214221
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background In 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. Methods We 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. Results BAR, 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. Conclusions Out 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.
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