文摘

Purpose The MELD-score was shown to be able to predict 90-day mortality in most patients with end-stage liver disease prior to liver transplantation and is used as a widely accepted measure for transplantation urgency. Prognostic ability of the BAR-score to predict 90-day post-transplant mortality by detection of unfavourable pretransplant combinations of donor and recipient factors may help to better balance urgency versus utility. Methods Two German cohorts (Hannover, n--53; Kiel, n--34) were retrospectively analyzed using ROC-curve analysis, goodness-of-model-fit tests, summary measures and risk-adjusted multivariate binary regression. Included were all consecutive liver transplants performed in adult recipients (minimum age 18?years). Excluded were all combined transplants and living-related organ donor transplants. Results Risk-adjusted multivariate regression revealed that the BAR-score is an independent risk factor for 90-day mortality after transplantation in both cohorts from Hannover and Kiel combined (p--.001, OR--.017, 95?% CI:1.031-.113). The area under the ROC-curve (AUROC) for the prediction of 90-day mortality using the BAR-score was 0.662 (95?% CI 0.624-.699, power >95?%). Measures for association between observed 90-day mortality and the predicted probabilities in the combined cohort were concordant in 63.5?% with low summary measures (Somers-D test 0.32, Goodman-Kruskal Gamma test 0.34 and Kendall’s Tau a test 0.07). Conclusions The BAR-score performed below accepted thresholds for potentially useful clinical prognostic models. Prognostic models with better predictive ability with AUROCs >0.700, concordance >70?% and larger summary measures are required for the prediction of 90-day post-transplant mortality to enable donor organ allocation with reliable weighing of urgency versus utility.