The BAR Score Predicts and Stratifies Outcomes Following Liver Retransplantation: Insights From a Retrospective Cohort Study
Liver retransplantation (reLT) yields poorer outcomes than primary liver transplantation, necessitating careful patient selection to avoid futile reLT. We conducted a retrospective analysis to assess reLT outcomes and identify associated risk factors. All adult patients who underwent a first reLT at...
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| Published in | Transplant international Vol. 37; p. 12104 |
|---|---|
| Main Authors | , , , , , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
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Switzerland
Frontiers Media SA
2024
Frontiers Media S.A |
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| Online Access | Get full text |
| ISSN | 1432-2277 0934-0874 1432-2277 |
| DOI | 10.3389/ti.2024.12104 |
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| Abstract | Liver retransplantation (reLT) yields poorer outcomes than primary liver transplantation, necessitating careful patient selection to avoid futile reLT. We conducted a retrospective analysis to assess reLT outcomes and identify associated risk factors. All adult patients who underwent a first reLT at the Medical University of Innsbruck from 2000 to 2021 (N = 111) were included. Graft- and patient survival were assessed via Kaplan-Meier plots and log-rank tests. Uni- and multivariate analyses were performed to identify independent predictors of graft loss. Five-year graft- and patient survival rates were 64.9% and 67.6%, respectively. The balance of risk (BAR) score was found to correlate with and be predictive of graft loss and patient death. The BAR score also predicted sepsis (AUC 0.676) and major complications (AUC 0.720). Multivariate Cox regression analysis identified sepsis [HR 5.179 (95% CI 2.575–10.417),
p
< 0.001] as the most significant independent risk factor for graft loss. At a cutoff of 18 points, the 5 year graft survival rate fell below 50%. The BAR score, a simple and easy to use score available at the time of organ acceptance, predicts and stratifies clinically relevant outcomes following reLT and may aid in clinical decision-making. |
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| AbstractList | Liver retransplantation (reLT) yields poorer outcomes than primary liver transplantation, necessitating careful patient selection to avoid futile reLT. We conducted a retrospective analysis to assess reLT outcomes and identify associated risk factors. All adult patients who underwent a first reLT at the Medical University of Innsbruck from 2000 to 2021 (N = 111) were included. Graft- and patient survival were assessed via Kaplan-Meier plots and log-rank tests. Uni- and multivariate analyses were performed to identify independent predictors of graft loss. Five-year graft- and patient survival rates were 64.9% and 67.6%, respectively. The balance of risk (BAR) score was found to correlate with and be predictive of graft loss and patient death. The BAR score also predicted sepsis (AUC 0.676) and major complications (AUC 0.720). Multivariate Cox regression analysis identified sepsis [HR 5.179 (95% CI 2.575-10.417), p < 0.001] as the most significant independent risk factor for graft loss. At a cutoff of 18 points, the 5 year graft survival rate fell below 50%. The BAR score, a simple and easy to use score available at the time of organ acceptance, predicts and stratifies clinically relevant outcomes following reLT and may aid in clinical decision-making.Liver retransplantation (reLT) yields poorer outcomes than primary liver transplantation, necessitating careful patient selection to avoid futile reLT. We conducted a retrospective analysis to assess reLT outcomes and identify associated risk factors. All adult patients who underwent a first reLT at the Medical University of Innsbruck from 2000 to 2021 (N = 111) were included. Graft- and patient survival were assessed via Kaplan-Meier plots and log-rank tests. Uni- and multivariate analyses were performed to identify independent predictors of graft loss. Five-year graft- and patient survival rates were 64.9% and 67.6%, respectively. The balance of risk (BAR) score was found to correlate with and be predictive of graft loss and patient death. The BAR score also predicted sepsis (AUC 0.676) and major complications (AUC 0.720). Multivariate Cox regression analysis identified sepsis [HR 5.179 (95% CI 2.575-10.417), p < 0.001] as the most significant independent risk factor for graft loss. At a cutoff of 18 points, the 5 year graft survival rate fell below 50%. The BAR score, a simple and easy to use score available at the time of organ acceptance, predicts and stratifies clinically relevant outcomes following reLT and may aid in clinical decision-making. Liver retransplantation (reLT) yields poorer outcomes than primary liver transplantation, necessitating careful patient selection to avoid futile reLT. We conducted a retrospective analysis to assess reLT outcomes and identify associated risk factors. All adult patients who underwent a first reLT at the Medical University of Innsbruck from 2000 to 2021 (N = 111) were included. Graft- and patient survival were assessed via Kaplan-Meier plots and log-rank tests. Uni- and multivariate analyses were performed to identify independent predictors of graft loss. Five-year graft- and patient survival rates were 64.9% and 67.6%, respectively. The balance of risk (BAR) score was found to correlate with and be predictive of graft loss and patient death. The BAR score also predicted sepsis (AUC 0.676) and major complications (AUC 0.720). Multivariate Cox regression analysis identified sepsis [HR 5.179 (95% CI 2.575–10.417), p < 0.001] as the most significant independent risk factor for graft loss. At a cutoff of 18 points, the 5 year graft survival rate fell below 50%. The BAR score, a simple and easy to use score available at the time of organ acceptance, predicts and stratifies clinically relevant outcomes following reLT and may aid in clinical decision-making. Liver retransplantation (reLT) yields poorer outcomes than primary liver transplantation, necessitating careful patient selection to avoid futile reLT. We conducted a retrospective analysis to assess reLT outcomes and identify associated risk factors. All adult patients who underwent a first reLT at the Medical University of Innsbruck from 2000 to 2021 (N = 111) were included. Graft- and patient survival were assessed via Kaplan-Meier plots and log-rank tests. Uni- and multivariate analyses were performed to identify independent predictors of graft loss. Five-year graft- and patient survival rates were 64.9% and 67.6%, respectively. The balance of risk (BAR) score was found to correlate with and be predictive of graft loss and patient death. The BAR score also predicted sepsis (AUC 0.676) and major complications (AUC 0.720). Multivariate Cox regression analysis identified sepsis [HR 5.179 (95% CI 2.575–10.417), p < 0.001] as the most significant independent risk factor for graft loss. At a cutoff of 18 points, the 5 year graft survival rate fell below 50%. The BAR score, a simple and easy to use score available at the time of organ acceptance, predicts and stratifies clinically relevant outcomes following reLT and may aid in clinical decision-making. Liver retransplantation (reLT) yields poorer outcomes than primary liver transplantation, necessitating careful patient selection to avoid futile reLT. We conducted a retrospective analysis to assess reLT outcomes and identify associated risk factors. All adult patients who underwent a first reLT at the Medical University of Innsbruck from 2000 to 2021 (N = 111) were included. Graft- and patient survival were assessed via Kaplan-Meier plots and log-rank tests. Uni- and multivariate analyses were performed to identify independent predictors of graft loss. Five-year graft- and patient survival rates were 64.9% and 67.6%, respectively. The balance of risk (BAR) score was found to correlate with and be predictive of graft loss and patient death. The BAR score also predicted sepsis (AUC 0.676) and major complications (AUC 0.720). Multivariate Cox regression analysis identified sepsis [HR 5.179 (95% CI 2.575–10.417), p < 0.001] as the most significant independent risk factor for graft loss. At a cutoff of 18 points, the 5 year graft survival rate fell below 50%. The BAR score, a simple and easy to use score available at the time of organ acceptance, predicts and stratifies clinically relevant outcomes following reLT and may aid in clinical decision-making. Liver retransplantation (reLT) yields poorer outcomes than primary liver transplantation, necessitating careful patient selection to avoid futile reLT. We conducted a retrospective analysis to assess reLT outcomes and identify associated risk factors. All adult patients who underwent a first reLT at the Medical University of Innsbruck from 2000 to 2021 (N = 111) were included. Graft- and patient survival were assessed via Kaplan-Meier plots and log-rank tests. Uni- and multivariate analyses were performed to identify independent predictors of graft loss. Five-year graft- and patient survival rates were 64.9% and 67.6%, respectively. The balance of risk (BAR) score was found to correlate with and be predictive of graft loss and patient death. The BAR score also predicted sepsis (AUC 0.676) and major complications (AUC 0.720). Multivariate Cox regression analysis identified sepsis [HR 5.179 (95% CI 2.575-10.417), < 0.001] as the most significant independent risk factor for graft loss. At a cutoff of 18 points, the 5 year graft survival rate fell below 50%. The BAR score, a simple and easy to use score available at the time of organ acceptance, predicts and stratifies clinically relevant outcomes following reLT and may aid in clinical decision-making. |
| Author | Cardini, Benno Resch, Thomas Buch, Madita L. Zoller, Heinz Krendl, Felix J. Maglione, Manuel Schneeberger, Stefan Tilg, Herbert Hell, Tobias Fodor, Margot Singh, Jessica Margreiter, Christian Schlosser, Lisa Esser, Hannah Schaefer, Benedikt Oberhuber, Rupert |
| AuthorAffiliation | 3 Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism , Medical University of Innsbruck , Innsbruck , Austria 1 Department of Visceral, Transplant and Thoracic Surgery , Center for Operative Medicine , Medical University of Innsbruck , Innsbruck , Austria 2 Department of Mathematics , Innsbruck , Austria |
| AuthorAffiliation_xml | – name: 2 Department of Mathematics , Innsbruck , Austria – name: 3 Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology and Metabolism , Medical University of Innsbruck , Innsbruck , Austria – name: 1 Department of Visceral, Transplant and Thoracic Surgery , Center for Operative Medicine , Medical University of Innsbruck , Innsbruck , Austria |
| Author_xml | – sequence: 1 givenname: Felix J. surname: Krendl fullname: Krendl, Felix J. – sequence: 2 givenname: Margot surname: Fodor fullname: Fodor, Margot – sequence: 3 givenname: Madita L. surname: Buch fullname: Buch, Madita L. – sequence: 4 givenname: Jessica surname: Singh fullname: Singh, Jessica – sequence: 5 givenname: Hannah surname: Esser fullname: Esser, Hannah – sequence: 6 givenname: Benno surname: Cardini fullname: Cardini, Benno – sequence: 7 givenname: Thomas surname: Resch fullname: Resch, Thomas – sequence: 8 givenname: Manuel surname: Maglione fullname: Maglione, Manuel – sequence: 9 givenname: Christian surname: Margreiter fullname: Margreiter, Christian – sequence: 10 givenname: Lisa surname: Schlosser fullname: Schlosser, Lisa – sequence: 11 givenname: Tobias surname: Hell fullname: Hell, Tobias – sequence: 12 givenname: Benedikt surname: Schaefer fullname: Schaefer, Benedikt – sequence: 13 givenname: Heinz surname: Zoller fullname: Zoller, Heinz – sequence: 14 givenname: Herbert surname: Tilg fullname: Tilg, Herbert – sequence: 15 givenname: Stefan surname: Schneeberger fullname: Schneeberger, Stefan – sequence: 16 givenname: Rupert surname: Oberhuber fullname: Oberhuber, Rupert |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/38304197$$D View this record in MEDLINE/PubMed |
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| Copyright | Copyright © 2024 Krendl, Fodor, Buch, Singh, Esser, Cardini, Resch, Maglione, Margreiter, Schlosser, Hell, Schaefer, Zoller, Tilg, Schneeberger and Oberhuber. 2024. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. Copyright © 2024 Krendl, Fodor, Buch, Singh, Esser, Cardini, Resch, Maglione, Margreiter, Schlosser, Hell, Schaefer, Zoller, Tilg, Schneeberger and Oberhuber. 2024 Krendl, Fodor, Buch, Singh, Esser, Cardini, Resch, Maglione, Margreiter, Schlosser, Hell, Schaefer, Zoller, Tilg, Schneeberger and Oberhuber |
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| Keywords | graft survival risk factors patient survival futility sepsis |
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| License | Copyright © 2024 Krendl, Fodor, Buch, Singh, Esser, Cardini, Resch, Maglione, Margreiter, Schlosser, Hell, Schaefer, Zoller, Tilg, Schneeberger and Oberhuber. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
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| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 Tobias Hell, Data Lab Hell GmbH, Zirl, Austria Present address: Lisa Schlosser, Data Lab Hell GmbH, Zirl, Austria These authors share first authorship |
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| SubjectTerms | Bile ducts Cholangitis Decision making futility graft survival Grafting Health Archive Liver Liver diseases Liver transplantation Multivariate analysis patient survival Patients Performance evaluation Rank tests Regression analysis Risk factors Sepsis Statistical analysis Survival Transplants & implants Variables |
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