TY - JOUR
T1 - The Liver Retransplantation Risk Score
T2 - a prognostic model for survival after adult liver retransplantation
AU - All the other contributing centers (www.eltr.org), the European Liver, Intestine Transplant Association (ELITA)
AU - Brüggenwirth, Isabel M A
AU - Werner, Maureen J M
AU - Adam, René
AU - Polak, Wojciech G
AU - Karam, Vincent
AU - Heneghan, Michael A
AU - Mehrabi, Arianeb
AU - Klempnauer, Jürgen L
AU - Paul, Andreas
AU - Mirza, Darius F
AU - Pratschke, Johann
AU - Salizzoni, Mauro
AU - Cherqui, Daniel
AU - Allison, Michael
AU - Soubrane, Olivier
AU - Staffa, Steven J
AU - Zurakowski, David
AU - Porte, Robert J
AU - de Meijer, Vincent E
N1 - This article is protected by copyright. All rights reserved.
PY - 2021/7/16
Y1 - 2021/7/16
N2 - High-risk combinations of recipient and graft characteristics are poorly defined for liver retransplantation (reLT) in the current era. We aimed to develop a risk model for survival after reLT using data from the European Liver Transplantation Registry, followed by internal and external validation. From 2006-2016, 85,067 LTs were recorded, including 5,581 reLTs (6.6%). The final model included seven predictors of graft survival: recipient age, model for end-stage liver disease score, indication for reLT, recipient hospitalization, time between primary liver transplantation and reLT, donor age, and cold ischemia time. By assigning points to each variable in proportion to their hazard ratio, a simplified risk score was created ranging 0-10. Low-risk (0-3), medium-risk (4-5), and high-risk (6-10) groups were identified with significantly different 5-year survival rates ranging 56.9% (95%CI 52.8%-60.7%), 46.3% (95%CI 41.1%-51.4%), and 32.1% (95%CI 23.5%-41.0%), respectively (P<0.001). External validation showed that the expected survival rates were closely aligned with the observed mortality probabilities. The Retransplantation Risk Score identifies high-risk combinations of recipient- and graft-related factors prognostic for long-term graft survival after reLT. This tool may serve as a guidance for clinical decision making on liver acceptance for reLT.
AB - High-risk combinations of recipient and graft characteristics are poorly defined for liver retransplantation (reLT) in the current era. We aimed to develop a risk model for survival after reLT using data from the European Liver Transplantation Registry, followed by internal and external validation. From 2006-2016, 85,067 LTs were recorded, including 5,581 reLTs (6.6%). The final model included seven predictors of graft survival: recipient age, model for end-stage liver disease score, indication for reLT, recipient hospitalization, time between primary liver transplantation and reLT, donor age, and cold ischemia time. By assigning points to each variable in proportion to their hazard ratio, a simplified risk score was created ranging 0-10. Low-risk (0-3), medium-risk (4-5), and high-risk (6-10) groups were identified with significantly different 5-year survival rates ranging 56.9% (95%CI 52.8%-60.7%), 46.3% (95%CI 41.1%-51.4%), and 32.1% (95%CI 23.5%-41.0%), respectively (P<0.001). External validation showed that the expected survival rates were closely aligned with the observed mortality probabilities. The Retransplantation Risk Score identifies high-risk combinations of recipient- and graft-related factors prognostic for long-term graft survival after reLT. This tool may serve as a guidance for clinical decision making on liver acceptance for reLT.
KW - European Liver and Intestine Transplant Association
KW - European Liver Transplant Registry
KW - graft survival
KW - liver transplantation
KW - risk assessment
KW - United Network for Organ Sharing
KW - TRANSPLANT REGISTRY
KW - GRAFT FAILURE
KW - INDEX
U2 - 10.1111/tri.13956
DO - 10.1111/tri.13956
M3 - Article
C2 - 34160850
SN - 0934-0874
VL - 34
SP - 1928
EP - 1937
JO - Transplant International
JF - Transplant International
IS - 10
ER -