Abstract
Background: We aimed to develop a novel scoring system for risk stratification specific to living donor liver transplantation (LDLT) recipients, to improve the accuracy of predicting short-term outcomes. Methods: The sequential organ failure assessment (SOFA) score at postoperative day 7 was collected and simplified by dichotomization, and these categories and other clinical factors were subjected to univariate and multivariate logistic regression analyses to select independent risks in constructing a “graft-to-recipient weight ratio (GRWR)-SOFA” scoring system. Results: We enrolled 519 patients who underwent LDLT. The GRWR-SOFA score comprises a sum of six factors: cardiovascular (mean arterial pressure < 70 mmHg, scored 3), coagulation (serum platelet < 50 × 103/μL, scored 2), renal (creatinine > 1.2 mg/dL, scored 2), liver (serum total bilirubin > 5.9 mg/dL, scored 5), neurological (Glasgow coma scale < 15, scored 2), and GRWR < 0.8, scored 2. The GRWR-SOFA contained four classes: The early mortality rate at 3 months and 1 year after LDLT was 1.3% and 6.9% for class I (scores of 0–4), 9.1% and 16.7% for class II (scores of 5–8), 25.5% and 34% for class III (scores of 9–10), and 61.3% and 67.7% for class IV (scores ≥ 11), respectively. The area under the receiver operating characteristic curve of GRWR-SOFA in the 3-month mortality prediction was 0.881 (95% confidence interval (CI): 0.818–0.944). Conclusions: The GRWR-SOFA model demonstrates superior discriminatory power for predicting short-term mortality. It enables clinicians to identify the right level of care for distinct subgroups of patients receiving LDLT.
Highlights
Liver transplantation (LT) is the treatment of choice for patients with acute liver failure, end-stage liver disease, or hepatocellular carcinoma
living donor liver transplantation (LDLT) has markedly advanced during the past decades, some recipients might still be confronted with adverse outcomes, especially in the early post-transplant period
There were 198 (38.2%) cases classified as Child–Pugh class C, and the mean model for end-stage liver disease (MELD) score was 16.9 ± 8.9 (8–40)
Summary
Liver transplantation (LT) is the treatment of choice for patients with acute liver failure, end-stage liver disease, or hepatocellular carcinoma. LDLT has markedly advanced during the past decades, some recipients might still be confronted with adverse outcomes, especially in the early post-transplant period. Clinicians have developed scoring systems or models that could predict adverse outcomes or mortality early after LT [3,4]. We aimed to develop a novel scoring system for risk stratification specific to living donor liver transplantation (LDLT) recipients, to improve the accuracy of predicting short-term outcomes. Methods: The sequential organ failure assessment (SOFA) score at postoperative day 7 was collected and simplified by dichotomization, and these categories and other clinical factors were subjected to univariate and multivariate logistic regression analyses to select independent risks in constructing a “graft-to-recipient weight ratio (GRWR)-SOFA” scoring system.
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