Prediction of post-transplant graft survival by different definitions of early allograft dysfunction

Abstract

Background: The efficacy of early allograft dysfunction (EAD) definitions in predicting post-transplant graft survival in a Chinese population is still unclear.Methods: A total of 607 orthotopic liver transplants (OLT) have been included in the current study. Model accuracy was evaluated using receiver operating characteristic (ROC) analysis. Risk factors for EAD was evaluated using univariable analysis and multivariable logistic regression model. Results:The 3-, 6-, and 12-month patient/graft survival were 91.6%/91.4%, 91.1%/90%, and 87.5%/87.3%, respectively. MELDPOD5 had a superior discrimination of 3-month graft survival (C statistic, 0.83), compared with MEAF (C statistic, 0.77) and Olthoff criteria (C statistic, 0.72). Multivariate analysis of risk factors for EAD defined by MELDPOD5, showed that donor body mass index (P=0.001), donor risk index (P=0.006), intraoperative use of packed red blood cells (P=0.001), hypertension of recipient (P=0.004), and preoperative total bilirubin (P<0.001) were independent risk factors. Conclusions:The results suggest that MLEDPOD5 is a better criterion of EAD for the Chinese population, which might serve as a surrogate end-point for graft survival in clinical study.

Early allograft dysfunction discovery and prognosis: does the Model for End-stage Liver Disease still prevail?

“…We read with great interest the article by Luo et al about comparison among Olthoff criteria, the Model for Endstage Liver Disease (MELD) score on postoperative day 5 (MELDPOD5), and the Model for Early Allograft Function scoring (MEAF) on their prognostic value for post-transplant graft and patient survival (1). Though all three metrics discriminated the high-risk patients from others effectively, MELDPOD5 displayed quite an advantage over MEAF and Olthoff criteria in predicting 3-month graft survival.…”