title: A score predicting survival after liver retransplantation for hepatitis C virus cirrhosis.
abstract: BACKGROUND
  Approximately one fourth of patients transplanted for hepatitis C virus (HCV)-induced liver failure progress to cirrhosis within 5 years, potentially requiring retransplantation. Although the relisting decision can be difficult in these patients, a score could help in selection of candidates with the best potential outcomes.
  
  
  METHODS
  A total of 1422 HCV-positive patients having undergone a retransplantation were included in this registry-based study. A multivariate Cox regression was performed, and an Akaike procedure was applied to design a score predicting survival after retransplantation and to allow an internal validation. Retained variables were donor age (DnAge), serum creatinine (Creat), International Normalized Ratio (INR), and serum albumin (Alb) at the second transplantation, recipient age (RecAge) at the first transplantation, and the interval between both transplantations (Int).
  
  
  RESULTS
  The score was designed as 0.23×DnAge+4.86×log Creat-2.45×log Int+2.69×INR+0.10×RecAge-3.27× Alb+40. The receiver operating characteristic area under curve was 0.643 at 3 years, and survivals were 71%, 56%, and 37% for scores <30, 30 to 40, and >40, respectively (log rank <0.0001).
  
  
  CONCLUSIONS
  Overall, the proposed score is specifically designed for HCV-positive patients, accurately predicts survival after a liver retransplantation, and is helpful in the selection of candidates with the best potential outcomes.
authors.affiliation: Abdominal and Transplantation Surgery, Department of Surgery, University Hospital Geneva, Switzerland.
authors.forename: Axel
authors.initials: A
authors.lastname: Andres
authors.forename: Eric
authors.initials: E
authors.lastname: Gerstel
authors.forename: Christophe
authors.initials: C
authors.lastname: Combescure
authors.forename: Sonal
authors.initials: S
authors.lastname: Asthana
authors.forename: Shaheed
authors.initials: S
authors.lastname: Merani
authors.forename: Pietro
authors.initials: P
authors.lastname: Majno
authors.forename: Thierry
authors.initials: T
authors.lastname: Berney
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
authors.forename: Norman
authors.initials: N
authors.lastname: Kneteman
authors.forename: Gilles
authors.initials: G
authors.lastname: Mentha
authors.forename: Christian
authors.initials: C
authors.lastname: Toso
mesh_terms: D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D019698:Hepatitis C, Chronic / Q000150:complications; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000401:mortality / Q000601:surgery* / Q000821:virology; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012008:Recurrence; D012042:Registries; D012086:Reoperation; D018570:Risk Assessment; D012307:Risk Factors; D013557:Switzerland; D013997:Time Factors; D014850:Waiting Lists