Model for End-Stage Liver Disease, Model for Liver Transplantation Survival and Donor Risk Index as predictive models of survival after liver transplantation in 1,006 patients
OBJECTIVES: Liver transplantation has not increased with the number of patients requiring this treatment, increasing deaths among those on the waiting list. Models predicting post-transplantation survival, including the Model for Liver Transplantation Survival and the Donor Risk Index, have been cre...
Main Authors: | , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Faculdade de Medicina / USP
2015-06-01
|
Series: | Clinics |
Subjects: | |
Online Access: | http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322015000600413&lng=en&tlng=en |
id |
doaj-84ad319a85a84a0ea5e59527429b3643 |
---|---|
record_format |
Article |
spelling |
doaj-84ad319a85a84a0ea5e59527429b36432020-11-25T01:48:48ZengFaculdade de Medicina / USPClinics1980-53222015-06-0170641341810.6061/clinics/2015(06)05S1807-59322015000600413Model for End-Stage Liver Disease, Model for Liver Transplantation Survival and Donor Risk Index as predictive models of survival after liver transplantation in 1,006 patientsElisa Maria de Camargo AranzanaAdriana Zuolo CoppiniMaurício Alves RibeiroPaulo Celso Bosco MassarolloLuiz Arnaldo SzutanFabio Gonçalves FerreiraOBJECTIVES: Liver transplantation has not increased with the number of patients requiring this treatment, increasing deaths among those on the waiting list. Models predicting post-transplantation survival, including the Model for Liver Transplantation Survival and the Donor Risk Index, have been created. Our aim was to compare the performance of the Model for End-Stage Liver Disease, the Model for Liver Transplantation Survival and the Donor Risk Index as prognostic models for survival after liver transplantation. METHOD: We retrospectively analyzed the data from 1,270 patients who received a liver transplant from a deceased donor in the state of São Paulo, Brazil, between July 2006 and July 2009. All data obtained from the Health Department of the State of São Paulo at the 15 registered transplant centers were analyzed. Patients younger than 13 years of age or with acute liver failure were excluded. RESULTS: The majority of the recipients had Child-Pugh class B or C cirrhosis (63.5%). Among the 1,006 patients included, 274 (27%) died. Univariate survival analysis using a Cox proportional hazards model showed hazard ratios of 1.02 and 1.43 for the Model for End-Stage Liver Disease and the Model for Liver Transplantation Survival, respectively (p <0.001). The areas under the ROC curve for the Donor Risk Index were always less than 0.5, whereas those for the Model for End-Stage Liver Disease and the Model for Liver Transplantation Survival were significantly greater than 0.5 (p <0.001). The cutoff values for the Model for End-Stage Liver Disease (≥29.5; sensitivity: 39.1%; specificity: 75.4%) and the Model for Liver Transplantation Survival (≥1.9; sensitivity 63.9%, specificity 54.5%), which were calculated using data available before liver transplantation, were good predictors of survival after liver transplantation (p <0.001). CONCLUSIONS: The Model for Liver Transplantation Survival displayed similar death prediction performance to that of the Model for End-Stage Liver Disease. A simpler model involving fewer variables, such as the Model for End-Stage Liver Disease, is preferred over a complex model involving more variables, such as the Model for Liver Transplantation Survival. The Donor Risk Index had no significance in post-transplantation survival in our patients.http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322015000600413&lng=en&tlng=enLiver transplantationModels, StatisticalEpidemiological factorsMortality |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Elisa Maria de Camargo Aranzana Adriana Zuolo Coppini Maurício Alves Ribeiro Paulo Celso Bosco Massarollo Luiz Arnaldo Szutan Fabio Gonçalves Ferreira |
spellingShingle |
Elisa Maria de Camargo Aranzana Adriana Zuolo Coppini Maurício Alves Ribeiro Paulo Celso Bosco Massarollo Luiz Arnaldo Szutan Fabio Gonçalves Ferreira Model for End-Stage Liver Disease, Model for Liver Transplantation Survival and Donor Risk Index as predictive models of survival after liver transplantation in 1,006 patients Clinics Liver transplantation Models, Statistical Epidemiological factors Mortality |
author_facet |
Elisa Maria de Camargo Aranzana Adriana Zuolo Coppini Maurício Alves Ribeiro Paulo Celso Bosco Massarollo Luiz Arnaldo Szutan Fabio Gonçalves Ferreira |
author_sort |
Elisa Maria de Camargo Aranzana |
title |
Model for End-Stage Liver Disease, Model for Liver Transplantation Survival and Donor Risk Index as predictive models of survival after liver transplantation in 1,006 patients |
title_short |
Model for End-Stage Liver Disease, Model for Liver Transplantation Survival and Donor Risk Index as predictive models of survival after liver transplantation in 1,006 patients |
title_full |
Model for End-Stage Liver Disease, Model for Liver Transplantation Survival and Donor Risk Index as predictive models of survival after liver transplantation in 1,006 patients |
title_fullStr |
Model for End-Stage Liver Disease, Model for Liver Transplantation Survival and Donor Risk Index as predictive models of survival after liver transplantation in 1,006 patients |
title_full_unstemmed |
Model for End-Stage Liver Disease, Model for Liver Transplantation Survival and Donor Risk Index as predictive models of survival after liver transplantation in 1,006 patients |
title_sort |
model for end-stage liver disease, model for liver transplantation survival and donor risk index as predictive models of survival after liver transplantation in 1,006 patients |
publisher |
Faculdade de Medicina / USP |
series |
Clinics |
issn |
1980-5322 |
publishDate |
2015-06-01 |
description |
OBJECTIVES: Liver transplantation has not increased with the number of patients requiring this treatment, increasing deaths among those on the waiting list. Models predicting post-transplantation survival, including the Model for Liver Transplantation Survival and the Donor Risk Index, have been created. Our aim was to compare the performance of the Model for End-Stage Liver Disease, the Model for Liver Transplantation Survival and the Donor Risk Index as prognostic models for survival after liver transplantation. METHOD: We retrospectively analyzed the data from 1,270 patients who received a liver transplant from a deceased donor in the state of São Paulo, Brazil, between July 2006 and July 2009. All data obtained from the Health Department of the State of São Paulo at the 15 registered transplant centers were analyzed. Patients younger than 13 years of age or with acute liver failure were excluded. RESULTS: The majority of the recipients had Child-Pugh class B or C cirrhosis (63.5%). Among the 1,006 patients included, 274 (27%) died. Univariate survival analysis using a Cox proportional hazards model showed hazard ratios of 1.02 and 1.43 for the Model for End-Stage Liver Disease and the Model for Liver Transplantation Survival, respectively (p <0.001). The areas under the ROC curve for the Donor Risk Index were always less than 0.5, whereas those for the Model for End-Stage Liver Disease and the Model for Liver Transplantation Survival were significantly greater than 0.5 (p <0.001). The cutoff values for the Model for End-Stage Liver Disease (≥29.5; sensitivity: 39.1%; specificity: 75.4%) and the Model for Liver Transplantation Survival (≥1.9; sensitivity 63.9%, specificity 54.5%), which were calculated using data available before liver transplantation, were good predictors of survival after liver transplantation (p <0.001). CONCLUSIONS: The Model for Liver Transplantation Survival displayed similar death prediction performance to that of the Model for End-Stage Liver Disease. A simpler model involving fewer variables, such as the Model for End-Stage Liver Disease, is preferred over a complex model involving more variables, such as the Model for Liver Transplantation Survival. The Donor Risk Index had no significance in post-transplantation survival in our patients. |
topic |
Liver transplantation Models, Statistical Epidemiological factors Mortality |
url |
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322015000600413&lng=en&tlng=en |
work_keys_str_mv |
AT elisamariadecamargoaranzana modelforendstageliverdiseasemodelforlivertransplantationsurvivalanddonorriskindexaspredictivemodelsofsurvivalafterlivertransplantationin1006patients AT adrianazuolocoppini modelforendstageliverdiseasemodelforlivertransplantationsurvivalanddonorriskindexaspredictivemodelsofsurvivalafterlivertransplantationin1006patients AT mauricioalvesribeiro modelforendstageliverdiseasemodelforlivertransplantationsurvivalanddonorriskindexaspredictivemodelsofsurvivalafterlivertransplantationin1006patients AT paulocelsoboscomassarollo modelforendstageliverdiseasemodelforlivertransplantationsurvivalanddonorriskindexaspredictivemodelsofsurvivalafterlivertransplantationin1006patients AT luizarnaldoszutan modelforendstageliverdiseasemodelforlivertransplantationsurvivalanddonorriskindexaspredictivemodelsofsurvivalafterlivertransplantationin1006patients AT fabiogoncalvesferreira modelforendstageliverdiseasemodelforlivertransplantationsurvivalanddonorriskindexaspredictivemodelsofsurvivalafterlivertransplantationin1006patients |
_version_ |
1725010064583950336 |