title: A Bayesian methodology to improve prediction of early graft loss after liver transplantation derived from the liver match study.
abstract: BACKGROUND
  To generate a robust predictive model of Early (3 months) Graft Loss after liver transplantation, we used a Bayesian approach to combine evidence from a prospective European cohort (Liver-Match) and the United Network for Organ Sharing registry.
  
  
  METHODS
  Liver-Match included 1480 consecutive primary liver transplants performed from 2007 to 2009 and the United Network for Organ Sharing a time-matched series of 9740 transplants. There were 173 and 706 Early Graft Loss, respectively. Multivariate analysis identified as significant predictors of Early Graft Loss: donor age, donation after cardiac death, cold ischaemia time, donor body mass index and height, recipient creatinine, bilirubin, disease aetiology, prior upper abdominal surgery and portal thrombosis.
  
  
  RESULTS
  A Bayesian Cox model was fitted to Liver-Match data using the United Network for Organ Sharing findings as prior information, allowing to generate an Early Graft Loss-Donor Risk Index and an Early Graft Loss-Recipient Risk Index. A Donor-Recipient Allocation Model, obtained by adding Early Graft Loss-Donor Risk Index to Early Graft Loss-Recipient Risk Index, was then validated in a distinct United Network for Organ Sharing (year 2010) cohort including 2964 transplants. Donor-Recipient Allocation Model updating using the independent Turin Transplant Centre dataset, allowed to predict Early Graft Loss with good accuracy (c-statistic: 0.76).
  
  
  CONCLUSIONS
  Donor-Recipient Allocation Model allows a reliable donor and recipient-based Early Graft Loss prediction. The Bayesian approach permits to adapt the original Donor-Recipient Allocation Model by incorporating evidence from other cohorts, resulting in significantly improved predictive capability.
authors.affiliation: Liver Unit, Tor Vergata University, Rome, Italy; Italian Association for the Study of the Liver (AISF), Italian National Transplant Centre (CNT) and Italian Liver Transplant Centres, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Angelico
authors.affiliation: Department of Mathematics, Tor Vergata University, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Nardi
authors.affiliation: Liver Transplant Unit, Azienda Ospedaliera Città della Salute e della Scienza, University of Turin, Italy; Italian Association for the Study of the Liver (AISF), Italian National Transplant Centre (CNT) and Italian Liver Transplant Centres, Italy. Electronic address: reromag@tin.it.
authors.forename: Renato
authors.initials: R
authors.lastname: Romagnoli
authors.affiliation: Liver Unit, Tor Vergata University, Rome, Italy; Italian Association for the Study of the Liver (AISF), Italian National Transplant Centre (CNT) and Italian Liver Transplant Centres, Italy.
authors.forename: Tania
authors.initials: T
authors.lastname: Marianelli
authors.affiliation: Gastroenterology Unit, La Sapienza University, Rome, Italy; Italian Association for the Study of the Liver (AISF), Italian National Transplant Centre (CNT) and Italian Liver Transplant Centres, Italy.
authors.forename: Stefano Ginanni
authors.initials: SG
authors.lastname: Corradini
authors.affiliation: Liver Transplant Unit, Azienda Ospedaliera Città della Salute e della Scienza, University of Turin, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Tandoi
authors.affiliation: Department of Mathematics, Tor Vergata University, Rome, Italy.
authors.forename: Caius
authors.initials: C
authors.lastname: Gavrila
authors.affiliation: Liver Transplant Unit, Azienda Ospedaliera Città della Salute e della Scienza, University of Turin, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
authors.affiliation: Liver Transplant Unit, University of Bologna, Italy.
authors.forename: Antonio D
authors.initials: AD
authors.lastname: Pinna
authors.affiliation: Liver Transplant Unit, Università of Padua, Italy; Italian Association for the Study of the Liver (AISF), Italian National Transplant Centre (CNT) and Italian Liver Transplant Centres, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Cillo
authors.affiliation: Centro Trapianti di Fegato, ISMETT, Palermo, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Gridelli
authors.affiliation: Liver Transplant Unit, Niguarda Hospital, Milan, Italy.
authors.forename: Luciano G
authors.initials: LG
authors.lastname: De Carlis
authors.affiliation: Centro Trapianti di Fegato, Ospedali Riuniti, Bergamo, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Colledan
authors.affiliation: Liver Transplant Unit, Università of Modena, Italy.
authors.forename: Giorgio E
authors.initials: GE
authors.lastname: Gerunda
authors.affiliation: National Transplant Centre, Rome, Italy.
authors.forename: Alessandro Nanni
authors.initials: AN
authors.lastname: Costa
authors.affiliation: Digestive Disease Section, University of Milan Bicocca, Milan, Italy; Yale University Liver Centre, New Haven, USA; Italian Association for the Study of the Liver (AISF), Italian National Transplant Centre (CNT) and Italian Liver Transplant Centres, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Strazzabosco
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001499:Bayes Theorem; D015992:Body Mass Index; D015331:Cohort Studies; D050377:Cold Ischemia / Q000706:statistics & numerical data; D051799:Delayed Graft Function / Q000453:epidemiology; D058625:End Stage Liver Disease / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055031:Primary Graft Dysfunction / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: Donor Risk Index; Donor-recipient match; Graft failure; Hepatitis C; Risk factors; Transplantation outcome