The Liver Retransplantation Risk Score: a prognostic model for survival after adult liver retransplantation

the European Liver, Intestine Transplant Association (ELITA)

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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.

Original languageEnglish
Pages (from-to)1928-1937
Number of pages10
JournalTransplant International
Volume34
Issue number10
Early online date23 Jun 2021
DOIs
Publication statusPublished - Oct 2021

Bibliographical note

Funding Information:
We thank all centers contributing to the ELTR ( www.eltr.org ) and the European Liver and Intestine Transplant Association (ELITA). The ELTR is supported by a grant from Astellas, Novartis, Institut Georges Lopez, and Sandoz and logistic support from the Paul Brousse Hospital (Assistance Publique – Hôpitaux de Paris). The organ‐sharing organizations such as the French ABM (Sami Djabbour), the Dutch NTS (Cynthia Konijn), the Eurotransplant Foundation (Marieke van Meel), the Spanish ONT (Gloria de la Rosa), the UK‐Ireland NHSBT (Mike Chilton), and the Scandiatransplant (Ilse Duus Weinreich) are acknowledged for the data cross‐check and sharing with the ELTR.

Funding Information:
The authors have declared no funding. We thank all centers contributing to the ELTR (www.eltr.org) and the European Liver and Intestine Transplant Association (ELITA). The ELTR is supported by a grant from Astellas, Novartis, Institut Georges Lopez, and Sandoz and logistic support from the Paul Brousse Hospital (Assistance Publique ? H?pitaux de Paris). The organ-sharing organizations such as the French ABM (Sami Djabbour), the Dutch NTS (Cynthia Konijn), the Eurotransplant Foundation (Marieke van Meel), the Spanish ONT (Gloria de la Rosa), the UK-Ireland NHSBT (Mike Chilton), and the Scandiatransplant (Ilse Duus Weinreich) are acknowledged for the data cross-check and sharing with the ELTR.

Publisher Copyright:
© 2021 The Authors. Transplant International published by John Wiley & Sons Ltd on behalf of Steunstichting ESOT

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