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ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 38 Issue 2
Feb.  2022
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Article Navigation >  Journal of Clinical Hepatology  > 2022  >  38(2): 402-408

Establishment and validation of a risk prediction model for early-stage complications after liver transplantation

DOI: 10.3969/j.issn.1001-5256.2022.02.027
  • 1.

    Department of Liver Transplantation, Tianjin First Central Hospital, Tianjin 300110, China

  • 2.

    Department of Endocrinology, Tianjin Medical University Chu Hsien-I Memorial Hospital, Tianjin 300134, China

Research funding:

General Project of National Natural Science Foundation of China (81870444);

Natural Science Foundation of Tianjin (17JCQNJC12800)

More Information
  • Corresponding author: LI Jiang, E-mail: regnier@ibpc.fr
  • Received Date: 2021-07-30
  • Accepted Date: 2021-08-31
  • Published Date: 2022-02-20
    Abstract
  •   Objective  To investigate the risk factors for early-stage complications among liver transplant recipients, and to establish and validate a risk prediction model for early-stage complications after transplantation.  Methods  A retrospective analysis was performed for the clinical data of 234 patients who underwent orthotopic liver transplantation in Department of Liver Transplantation, Tianjin First Central Hospital, from January 2016 to December 2018. According to the presence or absence of Clavien-Dindo grade ≥Ⅲ complications after liver transplantation, the patients were divided into complication group with 97 patients and non-complication group with 137 patients. The two groups were compared in terms of the indices including age, sex, body mass index (BMI), blood type, psoas muscle thickness/height (PMTH), Controlling Nutritional Status (CONUT) score, Model for End-Stage Liver Disease (MELD) score, total serum bilirubin, serum creatinine, international normalized ratio of prothrombin time, blood urea nitrogen, hemoglobin, white blood cell count, platelet count, amount of intraoperative red blood cell transfusion, amount of frozen plasma transfusion, blood loss, anhepatic phase, time of operation, donor age, donor BMI, cold ischemia time of donor liver, and warm ischemia time of donor liver. The independent samples t-test was used for comparison of normally distributed continuous data between two groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test was used for comparison of categorical data between two groups. Univariate analysis and the binary logistic regression analysis were used to investigate the risk factors for early-stage complications after liver transplantation, and a risk prediction model for complications after liver transplantation was established based on the method for establishing a scoring system using the logistic model provided by Framingham Research Center. Internal validation of the model was performed by C-index, receiver operating characteristic (ROC) curve, calibration curve, and the Hosmer-Lemeshow test, and the decision curve was used to evaluate the clinical applicability of the model. The Kaplan-Meier method was used to compare the incidence rate of early-stage complications after liver transplantation between the patients with different risk scores.  Results  Compared with the non-complication group, the complication group had significantly higher MELD score, proportion of patients with low PMTH, total serum bilirubin, serum creatinine, blood urea nitrogen, CONUT score, amount of intraoperative red blood cell transfusion, and amount of frozen plasma transfusion, as well as a significantly lower level of hemoglobin (all P < 0.1). The multivariate binary logistic regression analysis showed that MELD score (odds ratio [OR]=1.104, 95% confidence interval [CI]: 1.057-1.154, P < 0.05), PMTH (OR=2.858, 95%CI: 1.451-5.626, P < 0.05), and CONUT score (OR=1.481, 95%CI: 1.287-1.703, P < 0.05) were independent risk factors for grade ≥Ⅲ complications in the early stage after liver transplantation. MELD score, PMTH, and CONUT score were included in a predictive model, and this model had the highest score of 24 points, a C-index of 0.828, an area under the ROC curve of 0.812(P < 0.001), a sensitivity of 0.792, and a specificity of 0.751, suggesting that this predictive model had good discriminatory ability. The calibration curve of this model was close to the reference curve, and the Hosmer-Lemeshow test obtained a chi-square value of 8.528(P=0.382), suggesting that this predictive model had a high degree of fitting. The decision curve showed that most patients were able to benefit from the predictive model and achieved a high net benefit rate, suggesting that this predictive model had good clinical applicability. The score of 11 was selected as the cut-off value according to the optimal Youden index of 0.507, and the patients were divided into low-risk (< 8 points) group with 55 patients, moderate-risk (8-10 points) group with 63 patients, high-risk (11-14 points) group with 67 patients, and extremely high-risk (≥15 points) group with 49 patients. These four groups had a 90-day cumulative incidence rate of early-stage postoperative complications of 3.6%, 28.6%, 59.7%, and 75.5%, respectively, and the incidence rate of complications increased with the increase in risk score (P < 0.001).  Conclusion  MELD score, PMTH, and CONUT score are independent risk factors for early-stage complications among liver transplant recipients, and the risk prediction model established based on these factors has a high predictive value in high-risk patients.

     

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    • References(31)
  • [1]
    HOU JC, ZHENG H, QIANG Z, et al. Impact of psoas muscle index on early postoperative mortality and complications after liver transplantation[J]. Chin J Surg, 2018, 56(5): 374-378. DOI: 10.3760/cma.j.issn.0529-5815.2018.05.010.

    侯建存, 郑虹, 强喆, 等. 腰大肌指数对肝移植早期预后及并发症的影响[J]. 中华外科杂志, 2018, 56(5): 374-378. DOI: 10.3760/cma.j.issn.0529-5815.2018.05.010.
    [2]
    SAIMAN Y, SERPER M. Frailty and sarcopenia in patients pre- and post-liver transplant[J]. Clin Liver Dis, 2021, 25(1): 35-51. DOI: 10.1016/j.cld.2020.08.004.
    [3]
    LEE J, JEONG WK, KIM JH, et al. Serial Observations of muscle and fat mass as prognostic factors for deceased donor liver transplantation[J]. Korean J Radiol, 2021, 22(2): 189-197. DOI: 10.3348/kjr.2019.0750.
    [4]
    HUGUET A, LATOURNERIE M, DEBRY PH, et al. The psoas muscle transversal diameter predicts mortality in patients with cirrhosis on a waiting list for liver transplantation: A retrospective cohort study[J]. Nutrition, 2018, 51-52: 73-79. DOI: 10.1016/j.nut.2018.01.008.
    [5]
    IGNACIO de ULÍBARRI J, GONZÁLEZ-MADROÑO A, de VILLAR NG, et al. CONUT: A tool for controlling nutritional status. First validation in a hospital population[J]. Nutr Hosp, 2005, 20(1): 38-45.
    [6]
    KURODA D, SAWAYAMA H, KURASHIGE J, et al. Controlling Nutritional Status (CONUT) score is a prognostic marker for gastric cancer patients after curative resection[J]. Gastric Cancer, 2018, 21(2): 204-212. DOI: 10.1007/s10120-017-0744-3.
    [7]
    PRAVISANI R, MOCCHEGIANI F, ISOLA M, et al. Controlling Nutritional Status score does not predict patients' overall survival or hepatocellular carcinoma recurrence after deceased donor liver transplantation[J]. Clin Transplant, 2020, 34(3): e13786. DOI: 10.1111/ctr.13786.
    [8]
    FUKAMI Y, SAITO T, OSAWA T, et al. Preoperative controlling nutritional status plus tumor burden score for the assessment of prognosis after curative liver resection for hepatocellular carcinoma[J]. Med Princ Pract, 2021, 30(2): 131-137. DOI: 10.1159/000514031.
    [9]
    DINDO D, DEMARTINES N, CLAVIEN PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey[J]. Ann Surg, 2004, 240(2): 205-213. DOI: 10.1097/01.sla.0000133083.54934.ae.
    [10]
    LYU GY. Risk factors for biliary complications after liver transplantation from donation after cardiac death[J]. J Clin Hepatol, 2015, 31(12): 2027-2030. DOI: 10.3969/j.issn.1001-5256.2015.12.009.

    吕国悦. 心脏死亡供肝受体肝移植术后胆道并发症的危险因素探讨[J]. 临床肝胆病杂志, 2015, 31(12): 2027-2030. DOI: 10.3969/j.issn.1001-5256.2015.12.009.
    [11]
    SULLIVAN LM, MASSARO JM, SR DRB. Presentation of multivariate data for clinical use: The Framingham Study risk score functions[J]. Stat Med, 2004, 23(10): 1631-1660. DOI: 10.1002/sim.1742.
    [12]
    Branch of Organ Transplantation of Chinese Medical Association. Diagnosis and treatment specification for postoperative complications after liver transplantation in China (2019 edition)[J]. Organ Transpl, 2021, 12(2): 129-133. DOI: 10.3969/j.issn.1674-7445.2021.02.002.

    中华医学会器官移植学分会. 中国肝移植术后并发症诊疗规范(2019版)[J]. 器官移植, 2021, 12(2): 129-133. DOI: 10.3969/j.issn.1674-7445.2021.02.002.
    [13]
    Chinese Society of Hepatology, Chinese Medical Association, Chinese Society of Gastroenterology, Chinese Medical Association. Clinical guidelines on nutrition in end-stage liver disease[J]. J Clin Hepatol, 2019, 35(6): 1222-1230. DOI: 10.3969/j.issn.1001-5256.2019.06.010.

    中华医学会肝病学分会, 中华医学会消化病学分会. 终末期肝病临床营养指南[J]. 临床肝胆病杂志, 2019, 35(6): 1222-1230. DOI: 10.3969/j.issn.1001-5256.2019.06.010.
    [14]
    DOIJ, MORO A, FUJIKI M, et al. Nutrition support in liver transplantation and postoperative recovery: The effects of vitamin D level and vitamin D supplementation in liver transplantation[J]. Nutrients, 2020, 12(12): 3677. DOI: 10.3390/nu12123677.
    [15]
    TABERNA DJ, NAVAS-CARRETERO S, MARTINEZ JA. Current nutritional status assessment tools for metabolic care and clinical nutrition[J]. Curr Opin Clin Nutr Metab Care, 2019, 22(5): 323-328. DOI: 10.1097/MCO.0000000000000581.
    [16]
    MARESCHAL J, ACHAMRAH N, NORMAN K, et al. Clinical value of muscle mass assessment in clinical conditions associated with malnutrition[J]. J Clin Med, 2019, 8(7): 1040. DOI: 10.3390/jcm8071040.
    [17]
    CAMPOS DEL PORTILLO R, PALMA MIILA S, GARCÍA VÁQUEZ N, et al. Assessment of nutritional status in the healthcare setting in Spain[J]. Nutr Hosp, 2015, 31(Suppl 3): 196-208. DOI: 10.3305/nh.2015.31.sup3.8767.
    [18]
    BORHOFEN SM, GERNER C, LEHMANN J, et al. The royal free hospital-nutritional prioritizing tool is an independent predictor of deterioration of liver function and survival in cirrhosis[J]. Dig Dis Sci, 2016, 61(6): 1735-1743. DOI: 10.1007/s10620-015-4015-z.
    [19]
    European Association for the Study of the Liver. EASL clinical practice guidelines on nutrition in chronic liver disease[J]. J Hepatol, 2019, 70(1): 172-193. DOI: 10.1016/j.jhep.2018.06.024.
    [20]
    ENDO K, SATO T, KAKISAKA K, et al. Calf and arm circumference as simple markers for screening sarcopenia in patients with chronic liver disease[J]. Hepatol Res, 2021, 51(2): 176-189. DOI: 10.1111/hepr.13589.
    [21]
    YAO J, ZHOU X, YUAN L, et al. Prognostic value of the third lumbar skeletal muscle mass index in patients with liver cirrhosis and ascites[J]. Clin Nutr, 2020, 39(6): 1908-1913. DOI: 10.1016/j.clnu.2019.08.006.
    [22]
    GADDUCCI A, COSIO S. The prognostic relevance of computed tomography-assessed skeletal muscle index and skeletal muscle radiation attenuation in patients with gynecological cancer[J]. Anticancer Res, 2021, 41(1): 9-20. DOI: 10.21873/anticanres.14747.
    [23]
    MURRAY TÉ, WILLIAMS D, LEE MJ. Osteoporosis, obesity, and sarcopenia on abdominal CT: A review of epidemiology, diagnostic criteria, and management strategies for the reporting radiologist[J]. Abdom Radiol (NY), 2017, 42(9): 2376-2386. DOI: 10.1007/s00261-017-1124-5.
    [24]
    GU DH, KIM MY, SEO YS, et al. Clinical usefulness of psoas muscle thickness for the diagnosis of sarcopenia in patients with liver cirrhosis[J]. Clin Mol Hepatol, 2018, 24(3): 319-330. DOI: 10.3350/cmh.2017.0077.
    [25]
    LIGHTFOOT A, MCARDLE A, GRIFFITHS RD. Muscle in defense[J]. Crit Care Med, 2009, 37(10 Suppl): S384-S390. DOI: 10.1097/CCM.0b013e3181b6f8a5.
    [26]
    NEWSHOLME P. Why is L-glutamine metabolism important to cells of the immune system in health, postinjury, surgery or infection?[J]. J Nutr, 2001, 131(9 Suppl): 2515S-2522S; discussion 2523S-2524S. DOI: 10.1093/jn/131.9.2515S.
    [27]
    ROGERI PS, GASPARINI SO, MARTINS GL, et al. Crosstalk between skeletal muscle and immune system: Which roles do IL-6 and glutamine play?[J]. Front Physiol, 2020, 11: 582258. DOI: 10.3389/fphys.2020.582258.
    [28]
    BATATINHA H, BIONDO LA, LIRA FS, et al. Nutrients, immune system, and exercise: Where will it take us?[J]. Nutrition, 2019, 61: 151-156. DOI: 10.1016/j.nut.2018.09.019.
    [29]
    OKAZAKI T, SUZUKAMO Y, MIYATAKE M, et al. Respiratory muscle weakness as a risk factor for pneumonia in older people[J]. Gerontology, 2021, 67(5): 581-590. DOI: 10.1159/000514007.
    [30]
    NARWAL V, DESWAL R, BATRA B, et al. Cholesterol biosensors: A review[J]. Steroids, 2019, 143: 6-17. DOI: 10.1016/j.steroids.2018.12.003.
    [31]
    HAN S, KIM G, LEE SK, et al. Comparison of the tolerance of hepatic ischemia/reperfusion injury in living donors: Macrosteatosis versus microsteatosis[J]. Liver Transpl, 2014, 20(7): 775-783. DOI: 10.1002/lt.23878.
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