title: A score model for the continuous grading of early allograft dysfunction severity.
abstract: Early allograft dysfunction (EAD) dramatically influences graft and patient outcomes. A lack of consensus on an EAD definition hinders comparisons of liver transplant outcomes and management of recipients among and within centers. We sought to develop a model for the quantitative assessment of early allograft function [Model for Early Allograft Function Scoring (MEAF)] after transplantation. A retrospective study including 1026 consecutive liver transplants was performed for MEAF score development. Multivariate data analysis was used to select a small number of postoperative variables that adequately describe EAD. Then, the distribution of these variables was mathematically modeled to assign a score for each actual variable value. A model, based on easily obtainable clinical parameters (ie, alanine aminotransferase, international normalized ratio, and bilirubin) and scoring liver function from 0 to 10, was built. The MEAF score showed a significant association with patient and graft survival at 3-, 6- and 12-month follow-ups. Hepatic steatosis and age for donors; cold/warm ischemia times and postreperfusion syndrome for surgery; and intensive care unit and hospital stays, Model for End-Stage Liver Disease and Child-Pugh scores, body mass index, and fresh frozen plasma transfusions for recipients were factors associated significantly with EAD. The model was satisfactorily validated by its application to an independent set of 200 patients who underwent liver transplantation at a different center. In conclusion, a model for the quantitative assessment of EAD severity has been developed and validated for the first time. The MEAF provides a more accurate graft function assessment than current categorical classifications and may help clinicians to make early enough decisions on retransplantation benefits. Furthermore, the MEAF score is a predictor of recipient and graft survival. The standardization of the criteria used to define EAD may allow reliable comparisons of recipients' treatments and transplant outcomes among and within centers.
authors.affiliation: Unidad de Hepatología Experimental, Instituto de Investigación Sanitaria La Fe, Valencia, Spain.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Pareja
authors.forename: Miriam
authors.initials: M
authors.lastname: Cortes
authors.forename: David
authors.initials: D
authors.lastname: Hervás
authors.forename: José
authors.initials: J
authors.lastname: Mir
authors.forename: Andrés
authors.initials: A
authors.lastname: Valdivieso
authors.forename: José V
authors.initials: JV
authors.lastname: Castell
authors.forename: Agustín
authors.initials: A
authors.lastname: Lahoz
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D001499:Bayes Theorem; D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D004796:Clinical Enzyme Tests; D003661:Decision Support Techniques; D006085:Graft Survival; D006801:Humans; D019934:International Normalized Ratio; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D008954:Models, Biological; D015999:Multivariate Analysis; D017711:Nonlinear Dynamics; D011237:Predictive Value of Tests; D055031:Primary Graft Dysfunction / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D025341:Principal Component Analysis; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D000410:Alanine Transaminase; D001663:Bilirubin