Graft Risk Index After Liver Transplant: Internal and External Validation of a New Spanish Indicator.

Autor:	Araiz Burdio JJ; From the Intensive Care Unit, University Hospital Lozano Blesa; and the GIE of Critics, Health Research Institute of Aragon (IIS Aragon), the Transplant Procurement Management, University Hospital Lozano Blesa; and the Department of Medicine, University of Zaragoza, Zaragoza, Spain., Ocabo Buil P, Lacruz Lopez E, Diaz Mele MC, Rodríguez García A, Pascual Bielsa A, Zalba Etayo B, Virgós Señor B, Marin Araiz L, Suárez Pinilla MÁ
Jazyk:	angličtina
Zdroj:	Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation [Exp Clin Transplant] 2019 Dec; Vol. 17 (6), pp. 784-791. Date of Electronic Publication: 2019 May 14.
DOI:	10.6002/ect.2018.0342
Abstrakt:	Objectives: Scarcity of liver grafts has led to the use of marginal donors, consequently increasing the number of complications posttransplant. To prevent this situation, several indicators have been developed. However, important differences remain among countries. Here, we compared an early-risk liver transplant indicator based on the Spanish Liver Transplant Registry, called the Graft Risk Index, versus the US donor risk index and the Eurotransplant donor risk index. Materials and Methods: The new indicator was based on prospectively collected data from 600 adult liver transplants performed in our center. We considered 2 events to compare the indexes: graft survival and rejection-free graft survival, with Cox proportional regression for analyses. Power to predict graft survival was evaluated by calculating the receiver operating characteristic area under the curve. Results: We found no differences between the US and Eurotransplant donor risk indexes in prediction of patients with and without early graft failure. With regard to early survival, only the Graft Risk Index allowed better survival discrimination, in which survival progressively decreased with values ≥ 3 (with probability of graft survival at 1 month of 68%; 95% confidence interval, 46.2-82.5). This increase in risk was significant compared with the standard group (hazard ratio of 10.15; 95% confidence interval, C 3.91- 26.32; P < .001). We calculated powers of prediction of 0.52 (95% confidence interval, 0.43-0.62), 0.54 (95% confidence interval, 0.45-0.65), and 0.69 (95% confidence interval, 0.61-0.77) for donor risk index, Eurotransplant donor risk index, and early Graft Risk Index, respectively. Conclusions: Neither the US donor risk index nor the Eurotransplant donor risk index was valid for our Spanish liver donation and transplant program. Therefore, an indicator to predict posttransplant graft survival that is adapted to our environment is necessary. This national Graft Risk Index can be a useful tool to optimize donor-recipient matching.
Databáze:	MEDLINE
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