The Liver Retransplantation Risk Score: a prognostic model for survival after adult liver retransplantation |
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| Authors: | Isabel M. A. Brüggenwirth Maureen J. M. Werner René Adam Wojciech G. Polak Vincent Karam Michael A. Heneghan Arianeb Mehrabi Jürgen L. Klempnauer Andreas Paul Darius F. Mirza Johann Pratschke Mauro Salizzoni Daniel Cherqui Michael Allison Olivier Soubrane Steven J. Staffa David Zurakowski Robert J. Porte Vincent E. de Meijer all the other contributing centers (www.eltr.org) the European Liver Intestine Transplant Association (ELITA) |
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| Affiliation: | 1. Division of HPB Surgery and Liver Transplantation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;2. Centre Hépato-Biliaire, Inserm U935, Hôpital Universitaire Paul Brousse, Villejuif, France;3. Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands;4. Institute of Liver Studies, Kings College Hospital, London, UK;5. Department of General, Visceral and Transplant Surgery, Medical University Heidelberg, University Hospital, Heidelberg, Germany;6. Department of General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany;7. Department of General, Visceral and Transplantation Surgery, Essen University Hospital, Essen, Germany;8. Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK;9. Department of Surgery, Charité – Universitätsmedizin Berlin, Berlin, Germany;10. General Surgery 2U – Liver Transplant Unit, A.O.U. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy;11. Department of Surgery, Centre Hépato-Biliare, Inserm, Unit 1193, Paul-Brousse Hospital, Villejuif, France;12. Liver Unit, Department of Medicine, Cambridge Biomedical Research Centre, Cambridge, UK;13. Department of Hepatobiliopancreatic Surgery and Liver Transplantation, AP-HP, Beaujon Hospital, Clichy, France;14. Department of Anesthesiology, Critical Care and Pain Medicine, Harvard Medical School, Boston Children’s Hospital, Boston, MA, USA |
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| Abstract: | 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 to 2016, 85 067 liver transplants were recorded, including 5581 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. |
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| Keywords: | European Liver and Intestine Transplant Association European Liver Transplant Registry graft survival liver transplantation risk assessment United Network for Organ Sharing |
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