title: Prospective validation of a simple laboratory score to predict outcome after orthotopic liver transplantation.
abstract: OBJECTIVE
  To establish a score to predict 30-day mortality and graft loss retrospectively and to validate the score prospectively.
  
  
  METHODS
  Retrospectively in 296 liver transplant recipients, a score was developed that included the peak aspartate aminotransferase concentration within the first week and γ-glutamyltransferase and bilirubin concentrations at day 7 to predict graft loss or patient death within 30 days. The score was then prospectively validated in 86 patients undergoing liver transplantation.
  
  
  RESULTS
  From the retrospective training cohort, cut-off values for prediction of adverse outcomes were determined using receiver operating characteristic curve analysis for peak aspartate aminotransferase (>1870 IU/mL), γ-glutamyltransferase (<214 IU/mL), and bilirubin (>5.75 mg/dL). Sensitivity and specificity of the score to predict an end point from the retrospective cohort were excellently reproduced in the prospective cohort. Overall, fulfillment of at least 2 criteria predicted graft loss or death within 30 days with sensitivity of 0.70 and specificity of 0.78. No patients with values that remained below all 3 thresholds experienced graft loss or death within 30 days.
  
  
  CONCLUSIONS
  This simple score calculated from standard laboratory values within the first week after liver transplantation enables prediction of graft loss and patient death within 30 days after transplantation. Early identification of patients at risk may help to improve outcomes by observing these patients more closely and allocating resources for them.
authors.affiliation: Department General Surgery, University of Heidelberg, Heidelberg, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Schneider
authors.forename: S
authors.initials: S
authors.lastname: Latanowicz
authors.forename: M
authors.initials: M
authors.lastname: Spiegel
authors.forename: W
authors.initials: W
authors.lastname: Stremmel
authors.forename: M W
authors.initials: MW
authors.lastname: Büchler
authors.forename: J
authors.initials: J
authors.lastname: Schmidt
authors.forename: C
authors.initials: C
authors.lastname: Eisenbach
mesh_terms: D000328:Adult; D001219:Aspartate Aminotransferases / Q000097:blood; D001663:Bilirubin / Q000097:blood; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D001663:Bilirubin