Systematic review and validation of prognostic models in liver transplantation.
A model that can accurately predict post-liver transplant mortality would be useful for clinical decision making, would help to provide patients with prognostic information, and would facilitate fair comparisons of surgical performance between transplant units. A systematic review of the literature was carried out to assess the quality of the studies that developed and validated prognostic models for mortality after liver transplantation and to validate existing models in a large data set of patients transplanted in the United Kingdom (UK) and Ireland between March 1994 and September 2003. Five prognostic model papers were identified. The quality of the development and validation of all prognostic models was suboptimal according to an explicit assessment tool of the internal, external, and statistical validity, model evaluation, and practicality. The discriminatory ability of the identified models in the UK and Ireland data set was poor (area under the receiver operating characteristic curve always smaller than 0.7 for adult populations). Due to the poor quality of the reporting, the methodology used for the development of the model could not always be determined. In conclusion, these findings demonstrate that currently available prognostic models of mortality after liver transplantation can have only a limited role in clinical practice, audit, and research.
Jacob
Matthew
M
Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK.|Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
Lewsey
James D
JD
Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK.|Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
Sharpin
Carlos
C
Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
Gimson
Alexander
A
Liver Transplant Unit, Addenbrooke's Hospital, Cambridge, UK.
Rela
Mohammed
M
Institute of Liver Studies, King's College Hospital, London, UK.
van der Meulen
Jan H P
JHP
Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK.|Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.
D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D008962:Models, Theoretical; D011379:Prognosis