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Agopian, Vatche G, Markovic, Daniela, Klintmalm, Goran B, Saracino, Giovanna, Chapman, William C, Vachharajani, Neeta, Florman, Sander S, Tabrizian, Parissa, Haydel, Brandy, Nasralla, David, Friend, Peter J, Boteon, Yuri L, Ploeg, Rutger, Harlander-Locke, Michael P, Xia, Victor, DiNorcia, Joseph, Kaldas, Fady M, Yersiz, Hasan, Farmer, Douglas G and Busuttil, Ronald W (2020) Multicenter validation of the liver graft assessment following transplantation (L-GrAFT) score for assessment of early allograft dysfunction. Journal of hepatology. ISSN 1600-0641. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Full text not available from this repository.Abstract
BACKGROUND AIMS
Early allograft dysfunction (EAD) following liver transplantation (LT) negatively impacts graft and patient outcomes. The Liver Graft Assessment Following Transplantation (L-GrAFT) risk-score estimates 3-month graft-failure-free survival (area under the receiver operator characteristic [AUROC] curve=0.83), and was superior to the binary EAD (AUROC=0.68) definition and Model for Early Allograft Function (MEAF, AUROC=0.70) in the single-center derivation cohort (DC, n=2008). We sought to externally validate L-GrAFT, and compare its prognostic performance to EAD and MEAF.
METHODS
Accuracies of L-GrAFT, EAD, and MEAF were compared in a 3-center US validation cohort (VC, n=3201), and Consortium for Organ Preservation in Europe (COPE) normothermic machine perfusion trial cohort (n=222), with comparison of characteristics to assess generalizability.
RESULTS
Compared to the DC, VC and COPE patients had lower recipient median MELD scores (18 and 14 vs 31); were less likely to require pretransplant hospitalization (23.3% and 0% vs 46.1%), renal replacement therapy (8.8% and 1.8% vs 31.7%), mechanical ventilation (3.7% and 0% vs 19.8%); 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<0.001 for all comparisons). Despite significant differences in cohort characteristics, L-GrAFT maintained an excellent validation AUROC of 0.78, significantly superior to the EAD (AUROC=0.68, P=0.001) and MEAF scores (AUROC=0.72, P<0.001). In post-hoc analysis of COPE NMP trial, highest tertile of L-GrAFT was significantly associated with time to liver allograft (HR 2.17, P=0.016) and Clavien ≥IIIB (HR 2.60, P=0.034) and ≥IVa (HR 4.99, P=0.011) complications, and post-LT length of hospitalization (P=0.002) and renal replacement therapy (OR 3.62, P=0.016).
CONCLUSIONS
We have validated the L-GrAFT risk score as a generalizable, highly accurate, individualized risk assessment of 3-month liver allograft failure that is superior to the existing EAD and MEAF scores. L-GrAFT may standardize grading of early hepatic allograft function, and serve as a clinical end-point in translational studies aiming to mitigate ischemia-reperfusion injury.
LAY SUMMARY
Early allograft dysfunction negatively affects outcomes following liver transplantation (LT). In independent multicenter US and European cohorts totaling 3423 patients undergoing LT, 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-LT complications.
| Item Type: | Article |
|---|---|
| Additional Information: | This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs |
| Subjects: | WI Digestive system. Gastroenterology WO Surgery WO Surgery > WO500 Anaesthesia |
| Divisions: | Planned IP Care > Gastroentrology |
| Related URLs: | |
| Depositing User: | Jamie Edgar |
| Date Deposited: | 05 Oct 2020 11:10 |
| Last Modified: | 05 Oct 2020 11:10 |
| URI: | http://www.repository.uhblibrary.co.uk/id/eprint/3509 |
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