Associated Balance of Risk Score - Comprehensive Complication Index for the Prediction of Post-transplant Survival
Condition: Liver Cirrhosis; Liver Failure; Liver Diseases; Transplant Failure
MeSH terms: Liver Diseases; Liver Cirrhosis; Liver Failure
Study type: Observational

Summary: 
      In recent years, several scoring systems have been developed aimed at predicting early
      post-LT graft function. However, many of them showed poor efficacy when long-term survivals
      were tested. Moreover, the necessity to find an easy-to-use score represents another
      obstacle, with several scores composed by numerous, difficult to find, variables. Recently,
      the pre-LT Balance of Risk (BAR) and the post-LT Comprehensive Complication Index (CCI) have
      been created, but their external validation and integration in this setting is lacking.

      This study aims at constructing an easy-to-use score system based on the combination of a
      small number of pre- and immediately post-liver transplant (LT) independent variables, in
      order to accurately predict long-term graft survival after LT.
    

Detailed description: 
      In the last years, several scoring systems have been developed with the intent to predict
      waiting-list mortality or early allograft dysfunction (EAD) after liver transplantation (LT).
      The Model for End-stage Liver Disease (MELD) is recognised as the most accurate liver
      allograft allocation model by prioritising patients according to the severity of their
      disease. However, several studies showed that MELD alone failed to predict early and late
      post-transplant clinical course. Consequently, other scoring systems based on pre-LT or
      post-LT variables have been developed, with the intent to identify high-risk cases for death,
      graft loss or re-transplantation (re-LT). Among them, two pre-LT scores, namely the D-MELD
      and Balance of Risk (BAR), showed to well predict early post-LT survival. Similarly, some
      post-LT scores were able to estimate EAD, and, thereby, to predict the probabilities of early
      re-LT and patient death. Interestingly, all of these scores, especially those based on pre-LT
      variables, resulted in a scarce prediction of long-term (five-year) survivals.

      Recently, the Comprehensive Complication Index (CCI) has been developed in order to better
      capture complication rates after surgery. Some reports reported its excellent prognostic
      ability in different fields. However, up to now, no studies investigated the role of CCI
      concerning long-term prognostication of graft loss in LT.

      This study aims at constructing an easy-to-use score system based on the combination of a
      small number of pre- and immediately post-LT independent variables, in order to accurately
      predict five-year post-LT graft survival. Both external and internal validations of the score
      were performed.
    

Intervention name(s): Liver transplantation
Intervention type(s): Procedure
Intervention description(s): First deceased-donor liver transplantation
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        Adult patients transplanted for any liver pathology undergoing a first transplant.