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Transplantation
12, 2020;104 (12): e332-e341.

Preoperative Stratification of Liver Transplant Recipients: Validation of the LTRS.

Michele Molinari, Dana Jorgensen, Subhashini Ayloo, Stalin Dharmayan, Christof Kaltenmeier, Rajil B Mehta, Naudia Jonassaint
Author Information
  1. Michele Molinari: Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
  2. Dana Jorgensen: Division of Biostatistics, University of Pittsburgh Medical Center, Pittsburgh, PA.
  3. Subhashini Ayloo: Department of Surgery, Rutgers University, New Jersey Medical School, Newark, NJ.
  4. Stalin Dharmayan: Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
  5. Christof Kaltenmeier: Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
  6. Rajil B Mehta: Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
  7. Naudia Jonassaint: Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA.
PMID: 32675743 DOI: 10.1097/TP.0000000000003353

Abstract

BACKGROUND: The liver transplant risk score (LTRS) was developed to stratify 90-day mortality of patients referred for liver transplantation (LT). We aimed to validate the LTRS using a new cohort of patients.
METHODS: The LTRS stratifies the risk of 90-day mortality of LT recipients based on their age, body mass index, diabetes, model for end-stage liver disease (MELD) score, and need for dialysis. We assessed the performance of the LTRS using a new cohort of patients transplanted in the United States between July 2013 and June 2017. Exclusion criteria were age <18 years, ABO incompatibility, redo or multivisceral transplants, partial grafts, malignancies other than hepatocellular carcinoma and fulminant hepatitis.
RESULTS: We found a linear correlation between the number of points of the LTRS and 90-day mortality. Among 18 635 recipients, 90-day mortality was 2.7%, 3.8%, 5.2%, 4.8%, 6.7%, and 9.3% for recipients with 0, 1, 2, 3, 4, and ≥5 points (P < 0.001). The LTRS also stratified 1-year mortality that was 5.5%, 7.7%, 9.9%, 9.3%, 10.8%, and 15.4% for 0, 1, 2, 3, 4, and ≥5 points (P < 0.001). An inverse correlation was found between the LTRS and 4-year survival that was 82%, 79%, 78%, 82%, 78%, and 66% for patients with 0, 1, 2, 3, 4, and ≥5 points (P < 0.001). The LTRS remained an independent predictor after accounting for recipient sex, ethnicity, cause of liver disease, donor age, cold ischemia time, and waiting time.
CONCLUSIONS: The LTRS can stratify the short- and long-term outcomes of LT recipients at the time of their evaluations irrespective of their gender, ethnicity, and primary cause of liver disease.

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Grants

  1. T32 CA113263/NCI NIH HHS

MeSH Term

Aged
Decision Support Techniques
Female
Health Status Indicators
Humans
Liver Diseases
Liver Transplantation
Male
Middle Aged
Predictive Value of Tests
Registries
Reproducibility of Results
Retrospective Studies
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
United States
Journal Article Observational Study Validation Study
Article has an altmetric score of 2

Word Cloud

Created with Highcharts 10.0.0LTRSlivermortality90-daypatientsrecipientspoints234LTagedisease7%8%901≥5P < 0001timeriskscorestratifyusingnewcohortfoundcorrelation53%82%78%ethnicitycauseBACKGROUND:transplantdevelopedreferredtransplantationaimedvalidateMETHODS:stratifiesbasedbodymassindexdiabetesmodelend-stageMELDneeddialysisassessedperformancetransplantedUnitedStatesJuly2013June2017Exclusioncriteria<18yearsABOincompatibilityredomultivisceraltransplantspartialgraftsmalignancieshepatocellularcarcinomafulminanthepatitisRESULTS:linearnumberAmong18 6352%6alsostratified1-year5%79%10154%inverse4-yearsurvival79%66%remainedindependentpredictoraccountingrecipientsexdonorcoldischemiawaitingCONCLUSIONS:canshort-long-termoutcomesevaluationsirrespectivegenderprimaryPreoperativeStratificationLiverTransplantRecipients:Validation

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