Proposal for a New Predictive Model of Short-Term Mortality After Living Donor Liver Transplantation due to Acute Liver Failure
Hyun Sik Chung, Yu Jung Lee, Yun Sung Jo
(Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea)
Ann Transplant 2017; 22:101-107
Acute liver failure (ALF) is known to be a rapidly progressive and fatal disease. Various models which could help to estimate the post-transplant outcome for ALF have been developed; however, none of them have been proved to be the definitive predictive model of accuracy. We suggest a new predictive model, and investigated which model has the highest predictive accuracy for the short-term outcome in patients who underwent living donor liver transplantation (LDLT) due to ALF.
MATERIAL AND METHODS: Data from a total 88 patients were collected retrospectively. King’s College Hospital criteria (KCH), Child-Turcotte-Pugh (CTP) classification, and model for end-stage liver disease (MELD) score were calculated. Univariate analysis was performed, and then multivariate statistical adjustment for preoperative variables of ALF prognosis was performed. A new predictive model was developed, called the MELD conjugated serum phosphorus model (MELD-p). The individual diagnostic accuracy and cut-off value of models in predicting 3-month post-transplant mortality were evaluated using the area under the receiver operating characteristic curve (AUC). The difference in AUC between MELD-p and the other models was analyzed. The diagnostic improvement in MELD-p was assessed using the net reclassification improvement (NRI) and integrated discrimination improvement (IDI).
RESULTS: The MELD-p and MELD scores had high predictive accuracy (AUC >0.9). KCH and serum phosphorus had an acceptable predictive ability (AUC >0.7). The CTP classification failed to show discriminative accuracy in predicting 3-month post-transplant mortality. The difference in AUC between MELD-p and the other models had statistically significant associations with CTP and KCH. The cut-off value of MELD-p was 3.98 for predicting 3-month post-transplant mortality. The NRI was 9.9% and the IDI was 2.9%.
CONCLUSIONS: MELD-p score can predict 3-month post-transplant mortality better than other scoring systems after LDLT due to ALF. The recommended cut-off value of MELD-p is 3.98.
Keywords: Liver Failure, Acute, Liver Transplantation, Living Donors, Mortality, Patient Outcome Assessment, Prognosis