Prediction of Graft Survival Post-liver Transplantation by L-GrAFT Risk Score Model, EASE Score, MEAF Scoring, and EAD

Abstract

Background: Early allograft dysfunction (EAD) is correlated with poor patient or graft survival in liver transplantation. However, the power of distinct definitions of EAD in prediction of graft survival is unclear.Methods: This retrospective, single-center study reviewed data of 677 recipients undergoing orthotopic liver transplant between July 2015 and June 2020. The following EAD definitions were compared: liver graft assessment following transplantation (L-GrAFT) risk score model, early allograft failure simplified estimation score (EASE), model for early allograft function (MEAF) scoring, and Olthoff criteria. Risk factors for L-GrAFT7 high risk group were evaluated with univariate and multivariable logistic regression analysis.Results: L-GrAFT7 had a satisfied C-statistic of 0.87 in predicting a 3-month graft survival which significantly outperformed MEAF (C-statistic = 0.78, P = 0.01) and EAD (C-statistic = 0.75, P < 0.001), respectively. L-GrAFT10, EASE was similar to L-GrAFT7, and they had no statistical significance in predicting survival. Laboratory model for end-stage liver disease score and cold ischemia time are risk factors of L-GrAFT7 high-risk group.Conclusion: L-GrAFT7 risk score is capable for better predicting the 3-month graft survival than the MEAF and EAD in a Chinese cohort, which might standardize assessment of early graft function and serve as a surrogate endpoint in clinical trial.

Routine End-ischemic Hypothermic Oxygenated Machine Perfusion in Liver Transplantation from Donors After Brain Death

“…30,40 However, MEAF was chosen as a primary outcome measure for this study as it is a previously well-validated surrogate of early allograft function independently associated with the strongest clinical end-pointtransplant survival. [41][42][43] Importantly, MEAF was a significant predictor of both severe morbidity and mortality in all the patients included in the present study. Although the level of significance was not reached in the dHOPE group, the ORs for the association between MEAF and the development of severe complications were consistent in both arms.…”

“…The choice of primary outcome measure based on laboratory findings in machine perfusion trials is being widely criticized for unknown clinical relevance 30,40 . However, MEAF was chosen as a primary outcome measure for this study as it is a previously well-validated surrogate of early allograft function independently associated with the strongest clinical end-point – transplant survival 41–43 . Importantly, MEAF was a significant predictor of both severe morbidity and mortality in all the patients included in the present study.…”

Portable hypothermic oxygenated machine perfusion for organ preservation in liver transplantation: A randomized, open-label, clinical trial

“…Despite this, analysis of EAD approached the threshold of superiority for HMP-O 2 over conventional SCS. While EAD is a commonly used metric of graft function, its utility as a primary outcome measure has recently been re-evaluated due to its binary nature, 15 , 29 , 30 and it has become outdated. More robust graft dysfunction prediction modeling is employed by many groups.…”

From large-for-size to large-for-flow: A paradigm shift in liver transplantation

“…L-Graft7 was calculated for each included patient and divided into high and low-risk categories. High-risk included patients with L-graft7 <−1.5, as described in published data 18,19 . Secondary endpoints included early allograft dysfunction (EAD), 20 non-LGRM, including post-LT dialysis, surgical complications, 90-day and 1-year grafts, and recipient survival.…”