期刊
AMERICAN JOURNAL OF TRANSPLANTATION
卷 20, 期 9, 页码 2437-2448出版社
WILEY
DOI: 10.1111/ajt.15852
关键词
acute-on-chronic liver failure; clinical research; practice; ethics; ethics and public policy; liver disease; liver transplantation; liver transplantation; hepatology; organ allocation; organ procurement and allocation
The aim of this study was to produce a prognostic model to help predict posttransplant survival in patients transplanted with grade-3 acute-on-chronic liver failure (ACLF-3). Patients with ACLF-3 who underwent liver transplantation (LT) between 2007 and 2017 in 5 transplant centers were included (n = 152). Predictors of 1-year mortality were retrospectively screened and tested on a single center training cohort and subsequently tested on an independent multicenter cohort composed of the 4 other centers. Four independent pretransplant risk factors were associated with 1-year mortality after transplantation in the training cohort: age >= 53 years (P = .044), pre-LT arterial lactate level >= 4 mml/L (P = .013), mechanical ventilation with PaO2/FiO(2) <= 200 mm Hg (P = .026), and pre-LT leukocyte count <= 10 G/L (P = .004). A simplified version of the model was derived by assigning 1 point to each risk factor: the transplantation for Aclf-3 model (TAM) score. A cut-off at 2 points distinguished a high-risk group (score >2) from a low-risk group (score <= 2) with 1-year survival of 8.3% vs 83.9% respectively (P < .001). This model was subsequently validated in the independent multicenter cohort. The TAM score can help stratify posttransplant survival and identify an optimal transplantation window for patients with ACLF-3.
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