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Liver transplantation for critically ill cirrhotic patients: Stratifying utility based on pretransplant factors
Author(s) -
Artzner Thierry,
Michard Baptiste,
Weiss Emmanuel,
Barbier Louise,
Noorah Zair,
Merle JeanClaude,
PaugamBurtz Catherine,
Francoz Claire,
Durand François,
Soubrane Olivier,
Pirani Tasneem,
Theocharidou Eleni,
O’Grady John,
Bernal William,
Heaton Nigel,
Salamé Ephrem,
Bucur Petru,
Barraud Hélène,
Lefebvre François,
Serfaty Lawrence,
Besch Camille,
Bachellier Philippe,
Schneider Francis,
Levesque Eric,
Faitot François
Publication year - 2020
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15852
Subject(s) - medicine , cohort , liver transplantation , transplantation , retrospective cohort study , cohort study , mechanical ventilation , risk factor , surgery
The aim of this study was to produce a prognostic model to help predict posttransplant survival in patients transplanted with grade‐3 acute‐on‐chronic liver failure (ACLF‐3). Patients with ACLF‐3 who underwent liver transplantation (LT) between 2007 and 2017 in 5 transplant centers were included (n = 152). Predictors of 1‐year mortality were retrospectively screened and tested on a single center training cohort and subsequently tested on an independent multicenter cohort composed of the 4 other centers. Four independent pretransplant risk factors were associated with 1‐year mortality after transplantation in the training cohort: age ≥53 years ( P = .044), pre‐LT arterial lactate level ≥4 mml/L ( P = .013), mechanical ventilation with PaO 2 /FiO 2 ≤ 200 mm Hg ( P = .026), and pre‐LT leukocyte count ≤10 G/L ( P = .004). A simplified version of the model was derived by assigning 1 point to each risk factor: the transplantation for Aclf‐3 model (TAM) score. A cut‐off at 2 points distinguished a high‐risk group (score >2) from a low‐risk group (score ≤2) with 1‐year survival of 8.3% vs 83.9% respectively ( P < .001). This model was subsequently validated in the independent multicenter cohort. The TAM score can help stratify posttransplant survival and identify an optimal transplantation window for patients with ACLF‐3.