Multicenter validation of the liver graft assessment following transplantation (L-GrAFT) score for assessment of early allograft dysfunction
Multicenter validation of the liver graft assessment following transplantation (L-GrAFT) score for assessment of early allograft dysfunction
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DOI：
10.1016/j.jhep.2020.09.015
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发表时间：
2021-03-15
影响因子：
25.7
通讯作者：
Busuttil, Ronald W.
中科院分区：
文献类型：
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作者：
Agopian, Vatche G.;Markovic, Daniela;Busuttil, Ronald W.
背景与目的：肝移植（LT）后早期同种异体移植物功能障碍（EAD）对移植物和患者结局产生负面影响。之前我们报道了在单中心衍生队列中，移植后肝移植评估（L-GrAFT 7）风险评分上级二元EAD或早期同种异体移植功能模型（MEAF）评分，用于估计3个月无移植失败生存率。在此，我们试图从外部验证L-GrAFT 7，并将其预后性能与EAD和MEAF进行比较。方法：在美国3中心验证队列中比较L-GrAFT 7，EAD和MEAF的准确性（n = 3，201）和欧洲器官保存联盟（科普）常温机器灌注（NMP）试验队列（n = 222）;结果：与衍生队列相比，验证和NMP试验队列中的患者具有较低的受体中位MELD评分，不太可能需要移植前住院、肾脏替代治疗或机械通气;总体而言，1年的疗效优于上级（90%和95% vs. 84%）和无移植失败（88%和93% vs. 81%）存活率，3个月移植物失败的发生率较低（7.4%和4.0% vs. 11.1%; p = IVa（HR 4.99，p = 0.011））并发症; LT后住院时间结论：我们已经验证了L-GrAFT 7风险评分作为3个月肝移植失败的可推广的、高度准确的、个体化的风险评估上级现有评分。L-GrAFT 7可以标准化早期肝移植功能的分级，并作为转化研究中的临床终点（www.lgraft.com）。在总计3，423例接受肝移植的独立多中心美国和欧洲队列中，移植后肝移植评估（L-GrAFT）风险评分被验证为早期同种异体移植物功能的上级指标，可准确区分3个月移植物无衰竭生存期和肝移植后并发症。(C)2020年欧洲肝脏研究协会。Elsevier B. V.出版，保留所有权利。
Background & Aims: Early allograft dysfunction (EAD) following liver transplantation (LT) negatively impacts graft and patient outcomes. Previously we reported that the liver graft assessment following transplantation (L-GrAFT7) risk score was superior to binary EAD or the model for early allograft function (MEAF) score for estimating 3-month graft failure-free survival in a single center derivation cohort. Herein, we sought to externally validate L-GrAFT7, and compare its prognostic performance to EAD and MEAF.Methods: Accuracies of L-GrAFT7, EAD, and MEAF were compared in a 3-center US validation cohort (n = 3,201), and a Consortium for Organ Preservation in Europe (COPE) normothermic machine perfusion (NMP) trial cohort (n = 222); characteristics were compared to assess generalizability.Results: Compared to the derivation cohort, patients in the validation and NMP trial cohort had lower recipient median MELD scores; were less likely to require pretransplant hospitalization, renal replacement therapy or mechanical ventilation; and had superior 1-year overall (90% and 95% vs. 84%) and graft failure-free (88% and 93% vs. 81%) survival, with a lower incidence of 3-month graft failure (7.4% and 4.0% vs. 11.1%; p = IVa (HR 4.99, p = 0.011) complications; post-LT length of hospitalization (p = 0.002); and renal replacement therapy (odds ratio 3.62, p = 0.016).Conclusions: We have validated the L-GrAFT7 risk score as a generalizable, highly accurate, individualized risk assessment of 3-month liver allograft failure that is superior to existing scores. L-GrAFT7 may standardize grading of early hepatic allograft function and serve as a clinical endpoint in translational studies (www.lgraft.com).Lay summary: Early allograft dysfunction negatively affects outcomes following liver transplantation. In independent multicenter US and European cohorts totaling 3,423 patients undergoing liver transplantation, the liver graft assessment following transplantation (L-GrAFT) risk score is validated as a superior measure of early allograft function that accurately discriminates 3-month graft failure-free survival and post-liver transplantation complications. (C) 2020 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.